Bill Text: IL HB3286 | 2013-2014 | 98th General Assembly | Introduced

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Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. In addition to other specified criteria, provides that a Safety-Net Hospital is an Illinois hospital that is licensed by the Department of Public Health as a general acute care, psychiatric, or pediatric hospital (rather than a general acute care or pediatric hospital). Includes psychiatric hospitals to the types of hospitals that shall experience a 3.5% reduction in rates or payments for hospital services. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2014-12-03 - Session Sine Die [HB3286 Detail]

Download: Illinois-2013-HB3286-Introduced.html

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98TH GENERAL ASSEMBLY State of Illinois 2013 and 2014 HB3286 Introduced , by Rep. Naomi D. Jakobsson SYNOPSIS AS INTRODUCED:
305 ILCS 5/5-5e
305 ILCS 5/5-5e.1
Amends the Medical Assistance Article of the Illinois Public Aid Code. In addition to other specified criteria, provides that a Safety-Net Hospital is an Illinois hospital that is licensed by the Department of Public Health as a general acute care, psychiatric, or pediatric hospital (rather than a general acute care or pediatric hospital). Includes psychiatric hospitals to the types of hospitals that shall experience a 3.5% reduction in rates or payments for hospital services. Effective immediately.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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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 Illinois Public Aid Code is amended by
changing Sections 5-5e and 5-5e.1 as follows:
(305 ILCS 5/5-5e)
Sec. 5-5e. Adjusted rates of reimbursement.
(a) Rates or payments for services in effect on June 30,
2012 shall be adjusted and services shall be affected as
required by any other provision of this amendatory Act of the
97th General Assembly. In addition, the Department shall do the
following:
(1) Delink the per diem rate paid for supportive living
facility services from the per diem rate paid for nursing
facility services, effective for services provided on or
after May 1, 2011.
(2) Cease payment for bed reserves in nursing
facilities, specialized mental health rehabilitation
facilities, and, except in the instance of residents who
are under 21 years of age, intermediate care facilities for
persons with developmental disabilities.
(3) Cease payment of the $10 per day add-on payment to
nursing facilities for certain residents with

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developmental disabilities.
(b) After the application of subsection (a),
notwithstanding any other provision of this Code to the
contrary and to the extent permitted by federal law, on and
after July 1, 2012, the rates of reimbursement for services and
other payments provided under this Code shall further be
reduced as follows:
(1) Rates or payments for physician services, dental
services, or community health center services reimbursed
through an encounter rate, and services provided under the
Medicaid Rehabilitation Option of the Illinois Title XIX
State Plan shall not be further reduced.
(2) Rates or payments, or the portion thereof, paid to
a provider that is operated by a unit of local government
or State University that provides the non-federal share of
such services shall not be further reduced.
(3) Rates or payments for hospital services delivered
by a hospital defined as a Safety-Net Hospital under
Section 5-5e.1 of this Code shall not be further reduced.
(4) Rates or payments for hospital services delivered
by a Critical Access Hospital, which is an Illinois
hospital designated as a critical care hospital by the
Department of Public Health in accordance with 42 CFR 485,
Subpart F, shall not be further reduced.
(5) Rates or payments for Nursing Facility Services
shall only be further adjusted pursuant to Section 5-5.2 of

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this Code.
(6) Rates or payments for services delivered by long
term care facilities licensed under the ID/DD Community
Care Act and developmental training services shall not be
further reduced.
(7) Rates or payments for services provided under
capitation rates shall be adjusted taking into
consideration the rates reduction and covered services
required by this amendatory Act of the 97th General
Assembly.
(8) For hospitals not previously described in this
subsection or for a psychiatric hospital defined as a
Safety-Net Hospital under Section 5-5e.1 of this Code, the
rates or payments for hospital services shall be further
reduced by 3.5%, except for payments authorized under
Section 5A-12.4 of this Code.
(9) For all other rates or payments for services
delivered by providers not specifically referenced in
paragraphs (1) through (8), rates or payments shall be
further reduced by 2.7%.
(c) Any assessment imposed by this Code shall continue and
nothing in this Section shall be construed to cause it to
cease.
(Source: P.A. 97-689, eff. 6-14-12.)
(305 ILCS 5/5-5e.1)

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Sec. 5-5e.1. Safety-Net Hospitals.
(a) A Safety-Net Hospital is an Illinois hospital that:
(1) is licensed by the Department of Public Health as a
general acute care, psychiatric, or pediatric hospital;
and
(2) is a disproportionate share hospital, as described
in Section 1923 of the federal Social Security Act, as
determined by the Department; and
(3) meets one of the following:
(A) has a MIUR of at least 40% and a charity
percent of at least 4%; or
(B) has a MIUR of at least 50%.
(b) Definitions. As used in this Section:
(1) "Charity percent" means the ratio of (i) the
hospital's charity charges for services provided to
individuals without health insurance or another source of
third party coverage to (ii) the Illinois total hospital
charges, each as reported on the hospital's OBRA form.
(2) "MIUR" means Medicaid Inpatient Utilization Rate
and is defined as a fraction, the numerator of which is the
number of a hospital's inpatient days provided in the
hospital's fiscal year ending 3 years prior to the rate
year, to patients who, for such days, were eligible for
Medicaid under Title XIX of the federal Social Security
Act, 42 USC 1396a et seq., and the denominator of which is
the total number of the hospital's inpatient days in that

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same period.
(3) "OBRA form" means form HFS-3834, OBRA '93 data
collection form, for the rate year.
(4) "Rate year" means the 12-month period beginning on
October 1.
(c) For the 27-month period beginning July 1, 2012, a
hospital that would have qualified for the rate year beginning
October 1, 2011, shall be a Safety-Net Hospital.
(d) No later than August 15 preceding the rate year, each
hospital shall submit the OBRA form to the Department. Prior to
October 1, the Department shall notify each hospital whether it
has qualified as a Safety-Net Hospital.
(e) The Department may promulgate rules in order to
implement this Section.
(Source: P.A. 97-689, eff. 6-14-12.)