Bill Text: IL SB0774 | 2011-2012 | 97th General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning payment under the Medicaid program for obligations incurred but not paid for at the time of a recipient's death.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Failed) 2013-01-08 - Session Sine Die [SB0774 Detail]

Download: Illinois-2011-SB0774-Amended.html

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Sen. Jeffrey M. Schoenberg

Filed: 11/9/2011

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AMENDMENT TO SENATE BILL 774
AMENDMENT NO. ______. Amend Senate Bill 774 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Public Aid Code is amended by
changing Sections 5A-1, 5A-2, 5A-4, 5A-5, 5A-8, 5A-10, 5A-13,
and 5A-14 and by adding Section 5A-12.4 as follows:
(305 ILCS 5/5A-1) (from Ch. 23, par. 5A-1)
Sec. 5A-1. Definitions. As used in this Article, unless
the context requires otherwise:
"Adjusted gross hospital revenue" shall be determined
separately for inpatient and outpatient services for each
hospital conducted, operated or maintained by a hospital
provider, and means the hospital provider's total gross
revenues less: (i) gross revenue attributable to non-hospital
based services including home dialysis services, durable
medical equipment, ambulance services, outpatient clinics and

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any other non-hospital based services as determined by the
Illinois Department by rule; and (ii) gross revenues
attributable to the routine services provided to persons
receiving skilled or intermediate long-term care services
within the meaning of Title XVIII or XIX of the Social Security
Act; and (iii) Medicare gross revenue (excluding the Medicare
gross revenue attributable to clauses (i) and (ii) of this
paragraph and the Medicare gross revenue attributable to the
routine services provided to patients in a psychiatric
hospital, a rehabilitation hospital, a distinct part
psychiatric unit, a distinct part rehabilitation unit, or swing
beds). Adjusted gross hospital revenue shall be determined
using the most recent data available from each hospital's 2003
Medicare cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on December 31,
2004, without regard to any subsequent adjustments or changes
to such data. If a hospital's 2003 Medicare cost report is not
contained in the Healthcare Cost Report Information System, the
hospital provider shall furnish such cost report or the data
necessary to determine its adjusted gross hospital revenue as
required by rule by the Illinois Department.
"Fund" means the Hospital Provider Fund.
"Hospital" means an institution, place, building, or
agency located in this State that is subject to licensure by
the Illinois Department of Public Health under the Hospital
Licensing Act, whether public or private and whether organized

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for profit or not-for-profit.
"Hospital provider" means a person licensed by the
Department of Public Health to conduct, operate, or maintain a
hospital, regardless of whether the person is a Medicaid
provider. For purposes of this paragraph, "person" means any
political subdivision of the State, municipal corporation,
individual, firm, partnership, corporation, company, limited
liability company, association, joint stock association, or
trust, or a receiver, executor, trustee, guardian, or other
representative appointed by order of any court.
"Medicare bed days" means, for each hospital, the sum of
the number of days that each bed was occupied by a patient who
was covered by Title XVIII of the Social Security Act,
excluding days attributable to the routine services provided to
persons receiving skilled or intermediate long term care
services. Medicare bed days shall be computed separately for
each hospital operated or maintained by a hospital provider.
"Occupied bed days" means the sum of the number of days
that each bed was occupied by a patient for all beds, excluding
days attributable to the routine services provided to persons
receiving skilled or intermediate long term care services.
Occupied bed days shall be computed separately for each
hospital operated or maintained by a hospital provider.
"Outpatient gross revenue" means, for each hospital, its
total gross charges attributed to outpatient services as
reported on the Medicare cost report at Worksheet C, Part I,

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Column 7, line 101, less the sum of lines 45, 60, 63, 64, 65,
66, 67, and 68 (and any subsets of those lines).
"Proration factor" means a fraction, the numerator of which
is 53 and the denominator of which is 365.
(Source: P.A. 94-242, eff. 7-18-05; 95-859, eff. 8-19-08.)
(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
(Section scheduled to be repealed on July 1, 2014)
Sec. 5A-2. Assessment.
(a) Subject to Sections 5A-3 and 5A-10, an annual
assessment on inpatient services is imposed on each hospital
provider in an amount equal to the hospital's occupied bed days
multiplied by $84.19 multiplied by the proration factor for
State fiscal year 2004 and the hospital's occupied bed days
multiplied by $84.19 for State fiscal year 2005.
For State fiscal years 2004 and 2005, the Department of
Healthcare and Family Services shall use the number of occupied
bed days as reported by each hospital on the Annual Survey of
Hospitals conducted by the Department of Public Health to
calculate the hospital's annual assessment. If the sum of a
hospital's occupied bed days is not reported on the Annual
Survey of Hospitals or if there are data errors in the reported
sum of a hospital's occupied bed days as determined by the
Department of Healthcare and Family Services (formerly
Department of Public Aid), then the Department of Healthcare
and Family Services may obtain the sum of occupied bed days

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from any source available, including, but not limited to,
records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department of Healthcare and Family Services or its duly
authorized agents and employees.
Subject to Sections 5A-3 and 5A-10, for the privilege of
engaging in the occupation of hospital provider, beginning
August 1, 2005, an annual assessment is imposed on each
hospital provider for State fiscal years 2006, 2007, and 2008,
in an amount equal to 2.5835% of the hospital provider's
adjusted gross hospital revenue for inpatient services and
2.5835% of the hospital provider's adjusted gross hospital
revenue for outpatient services. If the hospital provider's
adjusted gross hospital revenue is not available, then the
Illinois Department may obtain the hospital provider's
adjusted gross hospital revenue from any source available,
including, but not limited to, records maintained by the
hospital provider, which may be inspected at all times during
business hours of the day by the Illinois Department or its
duly authorized agents and employees.
Subject to Sections 5A-3 and 5A-10, for State fiscal years
2009 through 2014, 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.
For State fiscal years 2009 through 2014, a hospital's

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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 by the Illinois Department or
its duly authorized agents and employees.
(b) (Blank).
(b-5) Subject to Sections 5A-3 and 5A-10, for State fiscal
years 2012 through 2014, an annual assessment on outpatient
services is imposed on each hospital provider in an amount
equal to .007236 multiplied by the hospital's outpatient gross
revenue. For State fiscal year 2012, the amount of the
assessment shall be prorated based on the portion of the fiscal
year for which it and the payments authorized under Section
5A-12.4 are in effect.
For State fiscal years 2012 through 2014, a hospital's
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

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

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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.
(Source: P.A. 95-859, eff. 8-19-08; 96-1530, eff. 2-16-11.)
(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

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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 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 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

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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.
Except as provided in subsection (a-5) of this Section, the
assessment imposed by subsection (b-5) of Section 5A-2 for
State fiscal year 2012 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 the 14th State
business day of each month. No installment payment of an
assessment imposed by subsection (b-5) of 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-12.4,
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 subsection (b-5) of 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-12.4. Upon notification to the Department of approval of the
payment methodologies required under Section 5A-12.4 and the
waiver granted under 42 CFR 433.68, if necessary, all
installments otherwise due under subsection (b-5) of Section

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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-12.4.
(a-5) The Illinois Department may, for the purpose of
maximizing federal revenue, accelerate the schedule upon which
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 or Section 5A-12.4 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 or Section 5A-12.4, by the
total assessment for the State fiscal year imposed under
Section 5A-2 or subsection (b-5) of 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

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imposed by Section 5A-2 a penalty assessment equal to the
lesser of (i) 5% of the amount of the installment not paid on
or before the due date plus 5% of the portion thereof remaining
unpaid on the last day of each 30-day period thereafter or (ii)
100% of the installment amount not paid on or before the due
date. For purposes of this subsection, payments will be
credited first to unpaid installment amounts (rather than to
penalty or interest), beginning with the most delinquent
installments.
(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. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08;
96-821, eff. 11-20-09.)
(305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5)
Sec. 5A-5. Notice; penalty; maintenance of records.
(a) The Department of Healthcare and Family Services shall
send a notice of assessment to every hospital provider subject
to assessment under this Article. The notice of assessment
shall notify the hospital of its assessment and shall be sent
after receipt by the Department of notification from the

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Centers for Medicare and Medicaid Services of the U.S.
Department of Health and Human Services that the payment
methodologies required under Section 5A-12, Section 5A-12.1,
or Section 5A-12.2, or Section 5A-12.4, whichever is applicable
for that fiscal year, and, if necessary, the waiver granted
under 42 CFR 433.68 have been approved. The notice shall be on
a form prepared by the Illinois Department and shall state the
following:
(1) The name of the hospital provider.
(2) The address of the hospital provider's principal
place of business from which the provider engages in the
occupation of hospital provider in this State, and the name
and address of each hospital operated, conducted, or
maintained by the provider in this State.
(3) The occupied bed days, occupied bed days less
Medicare days, or adjusted gross hospital revenue, or
outpatient gross revenue of the hospital provider
(whichever is applicable), the amount of assessment
imposed under Section 5A-2 for the State fiscal year for
which the notice is sent, and the amount of each
installment to be paid during the State fiscal year.
(4) (Blank).
(5) Other reasonable information as determined by the
Illinois Department.
(b) If a hospital provider conducts, operates, or maintains
more than one hospital licensed by the Illinois Department of

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Public Health, the provider shall pay the assessment for each
hospital separately.
(c) Notwithstanding any other provision in this Article, in
the case of a person who ceases to conduct, operate, or
maintain a hospital in respect of which the person is subject
to assessment under this Article as a hospital provider, the
assessment for the State fiscal year in which the cessation
occurs shall be adjusted by multiplying the assessment computed
under Section 5A-2 by a fraction, the numerator of which is the
number of days in the year during which the provider conducts,
operates, or maintains the hospital and the denominator of
which is 365. Immediately upon ceasing to conduct, operate, or
maintain a hospital, the person shall pay the assessment for
the year as so adjusted (to the extent not previously paid).
(d) Notwithstanding any other provision in this Article, a
provider who commences conducting, operating, or maintaining a
hospital, upon notice by the Illinois Department, shall pay the
assessment computed under Section 5A-2 and subsection (e) in
installments on the due dates stated in the notice and on the
regular installment due dates for the State fiscal year
occurring after the due dates of the initial notice.
(e) Notwithstanding any other provision in this Article,
for State fiscal years 2004 and 2005, in the case of a hospital
provider that did not conduct, operate, or maintain a hospital
throughout calendar year 2001, the assessment for that State
fiscal year shall be computed on the basis of hypothetical

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occupied bed days for the full calendar year as determined by
the Illinois Department. Notwithstanding any other provision
in this Article, for State fiscal years 2006 through 2008, in
the case of a hospital provider that did not conduct, operate,
or maintain a hospital in 2003, the assessment for that State
fiscal year shall be computed on the basis of hypothetical
adjusted gross hospital revenue for the hospital's first full
fiscal year as determined by the Illinois Department (which may
be based on annualization of the provider's actual revenues for
a portion of the year, or revenues of a comparable hospital for
the year, including revenues realized by a prior provider of
the same hospital during the year). Notwithstanding any other
provision in this Article, for State fiscal years 2009 through
2014, in the case of a hospital provider that did not conduct,
operate, or maintain a hospital in 2005, the assessment for
that State fiscal year shall be computed on the basis of
hypothetical occupied bed days for the full calendar year as
determined by the Illinois Department. Notwithstanding any
other provision in this Article, for State fiscal years 2012
through 2014, in the case of a hospital provider that did not
conduct, operate, or maintain a hospital in 2009, the
assessment under subsection (b-5) of Section 5A-2 for that
State fiscal year shall be computed on the basis of
hypothetical gross outpatient revenue for the full calendar
year as determined by the Illinois Department.
(f) Every hospital provider subject to assessment under

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this Article shall keep sufficient records to permit the
determination of adjusted gross hospital revenue for the
hospital's fiscal year. All such records shall be kept in the
English language and shall, at all times during regular
business hours of the day, be subject to inspection by the
Illinois Department or its duly authorized agents and
employees.
(g) The Illinois Department may, by rule, provide a
hospital provider a reasonable opportunity to request a
clarification or correction of any clerical or computational
errors contained in the calculation of its assessment, but such
corrections shall not extend to updating the cost report
information used to calculate the assessment.
(h) (Blank).
(Source: P.A. 95-331, eff. 8-21-07; 95-859, eff. 8-19-08;
96-1530, eff. 2-16-11.)
(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

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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, under the
Covering ALL KIDS Health Insurance Act, and under the
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

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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.
(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

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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.
(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 2014, 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

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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
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.
(7.10) For State fiscal year 2012, for making transfers
of the moneys resulting from the assessment under
subsection (b-5) of Section 5A-2 and 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 Care Provider Relief Fund......$10,000,000
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.
(7.11) For State fiscal years 2013 and 2014, for making
transfers of the moneys resulting from the assessment under
subsection (b-5) of Section 5A-2 and received from hospital

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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 Care Provider Relief Fund......$20,000,000
Transfers under this paragraph shall be made within 7
days after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(8) For making refunds to hospital providers pursuant
to Section 5A-10.
Disbursements from the Fund, other than transfers
authorized under paragraphs (5) and (6) of this subsection,
shall be by warrants drawn by the State Comptroller upon
receipt of vouchers duly executed and certified by the Illinois
Department.
(c) The Fund shall consist of the following:
(1) All moneys collected or received by the Illinois
Department from the hospital provider assessment imposed
by this Article.
(2) All federal matching funds received by the Illinois
Department as a result of expenditures made by the Illinois
Department that are attributable to moneys deposited in the
Fund.
(3) Any interest or penalty levied in conjunction with
the administration of this Article.

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(4) Moneys transferred from another fund in the State
treasury.
(5) All other moneys received for the Fund from any
other source, including interest earned thereon.
(d) (Blank).
(Source: P.A. 95-707, eff. 1-11-08; 95-859, eff. 8-19-08; 96-3,
eff. 2-27-09; 96-45, eff. 7-15-09; 96-821, eff. 11-20-09;
96-1530, eff. 2-16-11.)
(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
Sec. 5A-10. Applicability.
(a) The assessment imposed by subsection (a) of Section
5A-2 shall not take effect or shall cease to be imposed, and
any moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if:
(1) The sum of the appropriations for State fiscal
years 2004 and 2005 from the General Revenue Fund for
hospital payments under the medical assistance program is
less than $4,500,000,000 or the appropriation for each of
State fiscal years 2006, 2007 and 2008 from the General
Revenue Fund for hospital payments under the medical
assistance program is less than $2,500,000,000 increased
annually to reflect any increase in the number of
recipients, or the annual appropriation for State fiscal
years 2009, 2010, 2011, 2013, and 2014, from the General
Revenue Fund combined with the Hospital Provider Fund as

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authorized in Section 5A-8 for hospital payments under the
medical assistance program, is less than the amount
appropriated for State fiscal year 2009, adjusted annually
to reflect any change in the number of recipients,
excluding State fiscal year 2009 supplemental
appropriations made necessary by the enactment of the
American Recovery and Reinvestment Act of 2009; or
(2) For State fiscal years prior to State fiscal year
2009, the Department of Healthcare and Family Services
(formerly Department of Public Aid) makes changes in its
rules that reduce the hospital inpatient or outpatient
payment rates, including adjustment payment rates, in
effect on October 1, 2004, except for hospitals described
in subsection (b) of Section 5A-3 and except for changes in
the methodology for calculating outlier payments to
hospitals for exceptionally costly stays, so long as those
changes do not reduce aggregate expenditures below the
amount expended in State fiscal year 2005 for such
services; or
(2.1) For State fiscal years 2009 through 2014, the
Department of Healthcare and Family Services adopts any
administrative rule change to reduce payment rates or
alters any payment methodology that reduces any payment
rates made to operating hospitals under the approved Title
XIX or Title XXI State plan in effect January 1, 2008
except for:

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(A) any changes for hospitals described in
subsection (b) of Section 5A-3; or
(B) any rates for payments made under this Article
V-A; or
(C) any changes proposed in State plan amendment
transmittal numbers 08-01, 08-02, 08-04, 08-06, and
08-07; or
(D) in relation to any admissions on or after
January 1, 2011, a modification in the methodology for
calculating outlier payments to hospitals for
exceptionally costly stays, for hospitals reimbursed
under the diagnosis-related grouping methodology;
provided that the Department shall be limited to one
such modification during the 36-month period after the
effective date of this amendatory Act of the 96th
General Assembly; or
(3) The payments to hospitals required under Section
5A-12 or Section 5A-12.2 are changed or are not eligible
for federal matching funds under Title XIX or XXI of the
Social Security Act.
(b) The assessment imposed by Section 5A-2 shall not take
effect or shall cease to be imposed if the assessment is
determined to be an impermissible tax under Title XIX of the
Social Security Act. Moneys in the Hospital Provider Fund
derived from assessments imposed prior thereto shall be
disbursed in accordance with Section 5A-8 to the extent federal

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financial participation is not reduced due to the
impermissibility of the assessments, and any remaining moneys
shall be refunded to hospital providers in proportion to the
amounts paid by them.
(c) The assessments imposed by subsection (b-5) of Section
5A-2 shall not take effect or shall cease to be imposed, and
any moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if the
payments to hospitals required under Section 5A-12.4 are
changed or are not eligible for federal matching funds under
Title XIX of the Social Security Act.
(d) The assessments imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, and any moneys remaining
in the Fund shall be refunded to hospital providers in
proportion to the amounts paid by them, if:
(1) for State fiscal years 2012 through 2014, the
Department reduces any payment rates to hospitals as in
effect on November 1, 2011, or alters any payment
methodology as in effect on November 1, 2011, that has the
effect of reducing payment rates to hospitals; or
(2) for State fiscal years 2012 through 2014, the
Department reduces any supplemental payments made to
hospitals below the amounts paid for services provided in
State fiscal year 2011 as implemented by administrative
rules adopted and in effect on or prior to June 30, 2011.
(e) If the payments under Section 5A-12.4 are reduced

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pursuant to subsection (p) of Section 5A-12.4, then the
assessment rate imposed under subsection (b-5) of Section 5A-2
shall be reduced such that the aggregate assessment is reduced
by 50% of the amount of any reduction in payments pursuant to
subsection (p) of Section 5A-12.4.
(Source: P.A. 96-8, eff. 4-28-09; 96-1530, eff. 2-16-11; 97-72,
eff. 7-1-11; 97-74, eff. 6-30-11.)
(305 ILCS 5/5A-12.4 new)
Sec. 5A-12.4. Hospital access improvement payments on or
after January 1, 2012.
(a) Hospital access improvement payments. To preserve and
improve access to hospital services, for hospital and physician
services rendered on or after January 1, 2012, 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 7th 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

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government in an appropriate State Plan amendment and (ii) the
assessment imposed under subsection (b-5) of Section 5A-2 of
this Article is determined to be a permissible tax under Title
XIX of the Social Security Act. For State fiscal year 2012, the
amount of the payments shall be prorated based on the portion
of the fiscal year for which they and the assessment authorized
under subsection (b-5) of Section 5A-2 are in effect.
(a-5) Accelerated schedule. The Illinois Department may,
when practicable, accelerate the schedule upon which payments
authorized under this Section are made.
(b) Magnet and perinatal hospital adjustment. In addition
to rates paid for inpatient hospital services, the Department
shall pay to each Illinois general acute care hospital that, as
of August 25, 2011, was recognized as a Magnet hospital by the
American Nurses Credentialing Center and that, as of September
14, 2011, was designated as a level III perinatal center
amounts as follows:
(1) For hospitals with a case mix index equal to or
greater than the 80th percentile of case mix indices for
all Illinois hospitals, $380 for each Medicaid general
acute care inpatient day of care provided by the hospital
during State fiscal year 2009.
(2) For all other hospitals, $200 for each Medicaid
general acute care inpatient day of care provided by the
hospital during State fiscal year 2009.
(c) Trauma level II adjustment. In addition to rates paid

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for inpatient hospital services, the Department shall pay to
each Illinois general acute care hospital that, as of July 1,
2011, was designated as a level II trauma center amounts as
follows:
(1) For hospitals with a case mix index equal to or
greater than the 50th percentile of case mix indices for
all Illinois hospitals, $380 for each Medicaid general
acute care inpatient day of care provided by the hospital
during State fiscal year 2009.
(2) For all other hospitals, $135 for each Medicaid
general acute care inpatient day of care provided by the
hospital during State fiscal year 2009.
(3) For the purposes of this adjustment, hospitals
located in the same city that alternate their trauma center
designation as defined in 89 Ill. Adm. Code 148.295(a)(2)
shall have the adjustment provided under this section
divided between the 2 hospitals.
(d) Dual eligible 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 programs under Title XIX of the
Social Security Act administered by the Department (utilizing
information from 2009 paid claims) greater than 50%, and a case
mix index equal to or greater than the 75th percentile of case
mix indices for all Illinois hospitals, a rate of $380 for each
Medicaid inpatient day during State fiscal year 2009 including

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crossover days.
(e) Medicaid 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 10,000 Medicaid inpatient days of care in State fiscal
year 2009, has a Medicaid inpatient utilization rate of at
least 29.05% as calculated by the Department for the Rate Year
2011 Disproportionate Share determination, and is not eligible
for Medicaid Percentage Adjustment payments in rate year 2011
an amount equal to $75 for each Medicaid inpatient day of care
provided during State fiscal year 2009.
(f) Outpatient service adjustment. In addition to the rates
paid for outpatient hospital services, the Department shall pay
each Illinois hospital an amount at least equal to $100
multiplied by the hospital's outpatient ambulatory procedure
listing services (excluding categories 3B and 3C) and by the
hospital's end stage renal disease treatment services provided
for State fiscal year 2009.
(g) Care coordination adjustment.
(1) In addition to the rates paid for outpatient
hospital services provided in the emergency department,
the Department shall pay each Illinois hospital an amount
equal to $100 multiplied by the hospital's outpatient
ambulatory procedure listing services for categories 3A,
3B, and 3C for State fiscal year 2009.
(2) In addition to the rates paid for outpatient

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hospital services, the Department shall pay each Illinois
freestanding psychiatric hospital an amount equal to $100
multiplied by the hospital's ambulatory procedure listing
services for category 5A for State fiscal year 2009.
(3) In order to incentivize better coordination of care
for patients receiving emergency room services and
services related to behavioral health and substance abuse,
the Department may seek to have the care coordination
activities that are developed in consultation with a
statewide association representing hospitals and that are
supported by these adjustment payments considered under
Section 2703 of the Affordable Care Act.
(h) Specialty hospital adjustment. In addition to the rates
paid for outpatient hospital services, the Department shall pay
each Illinois long term acute care hospital and each Illinois
hospital devoted exclusively to the treatment of cancer, an
amount equal to $715 multiplied by the hospital's outpatient
ambulatory procedure listing services and by the hospital's end
stage renal disease treatment services (including services
provided to individuals eligible for both Medicaid and
Medicare) provided for State fiscal year 2009.
(i) Physician supplemental adjustment. In addition to the
rates paid for physician services, the Department shall make an
adjustment payment for services provided by physicians as
follows:
(1) Physician services eligible for the adjustment

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payment are those provided by physicians employed by or who
have an exclusive contract to provide services to patients
of the following hospitals: (i) Illinois general acute care
hospitals that provided at least 17,000 Medicaid inpatient
days of care in State fiscal year 2009 and had a Medicaid
inpatient utilization rate of at least 19.23% as calculated
by the Department for the Rate Year 2011 Disproportionate
Share determination; and (ii) Illinois freestanding
children's hospitals, as defined in 89 Ill. Adm. Code
149.50(c)(3)(A).
(2) The amount of the adjustment for each eligible
hospital under this subsection (i) shall be determined by
rule by the Department to spend a total pool of at least
$22,000,000 annually. This pool shall be allocated among
the eligible hospitals based on the difference between the
upper payment limit for what could have been paid under
Medicaid for physician services provided during State
fiscal year 2009 by physicians employed by or who had an
exclusive contract with the hospital and the amount that
was paid under Medicaid for such services, provided
however, that in no event shall physicians at any
individual hospital collectively receive an annual,
aggregate adjustment in excess of $1,000,000. Any amount
that is not distributed to a hospital because of the upper
payment limit shall be reallocated among the remaining
eligible hospitals that are below the upper payment

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limitation, on a proportionate basis.
(j) For purposes of this Section, a hospital that is
enrolled to provide Medicaid services during State fiscal year
2009 shall have its utilization and associated reimbursements
annualized prior to the payment calculations being performed
under this Section.
(k) 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.
(l) 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
October 1, 2011. Other terms shall be defined by the Illinois
Department by rule.
As used in this Section, unless the context requires
otherwise:
"Case mix index" means, for a given hospital, the sum of
the per admission (DRG) relative weighting factors in effect on
January 1, 2005, for all general acute care admissions for
State fiscal year 2009, excluding Medicare crossover

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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 2009, 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 2009
that was adjudicated by the Department through June 30, 2010.
"Outpatient ambulatory procedure listing services" means,
for a given hospital, 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 services 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 2009 that were adjudicated by the Department
through September 2, 2010.
"Outpatient end-stage renal disease treatment services"
means, for a given hospital, the services, as described in 89
Ill. Adm. Code 148.140(c), provided to recipients of medical

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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 2009 that were adjudicated by
the Department through September 2, 2010.
(m) The Department may adjust payments made under this
Section 5A-12.4 to comply with federal law or regulations
regarding hospital-specific payment limitations on
government-owned or government-operated hospitals.
(n) 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 (n) shall be given
retroactive effect so that they shall be deemed to have taken
effect as of the effective date of this Section.
(o) The Department of Healthcare and Family Services must
submit a State Medicaid Plan Amendment to the Centers of
Medicare and Medicaid Services to implement the payments under
this Section within 30 days of the effective date of this Act.
(p) If any of the federal upper payment limits applicable

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to the payments under this Section are exceeded due to an
expansion of the number of recipients enrolled in
fully-capitated, risk-based managed care arrangements prior to
the dates set forth in subsections (a) and (d) of Section
5A-14, the payments under this Section that exceed the
applicable federal upper payment limits may be reduced
uniformly to the extent necessary to comply with the applicable
federal upper payment limit.
(305 ILCS 5/5A-13)
Sec. 5A-13. Emergency rulemaking. The Department of
Healthcare and Family Services (formerly Department of Public
Aid) may adopt rules necessary to implement this amendatory Act
of the 94th General Assembly through the use of emergency
rulemaking in accordance with Section 5-45 of the Illinois
Administrative Procedure Act. For purposes of that Act, the
General Assembly finds that the adoption of rules to implement
this amendatory Act of the 94th General Assembly is deemed an
emergency and necessary for the public interest, safety, and
welfare.
The Department of Healthcare and Family Services may adopt
rules necessary to implement this amendatory Act of the 97th
General Assembly through the use of emergency rulemaking in
accordance with Section 5-45 of the Illinois Administrative
Procedure Act. For purposes of that Act, the General Assembly
finds that the adoption of rules to implement this amendatory

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Act of the 97th General Assembly is deemed an emergency and
necessary for the public interest, safety, and welfare.
(Source: P.A. 94-242, eff. 7-18-05; 95-331, eff. 8-21-07.)
(305 ILCS 5/5A-14)
Sec. 5A-14. Repeal of assessments and disbursements.
(a) Section 5A-2 is repealed on July 1, 2014.
(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 and Section 5A-12.4 are is repealed on
July 1, 2014.
(e) Section 5A-12.3 is repealed on July 1, 2011.
(Source: P.A. 95-859, eff. 8-19-08; 96-821, eff. 11-20-09;
96-1530, eff. 2-16-11.)
Section 99. Effective date. This Act takes effect upon
becoming law.".