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1		AN ACT concerning public aid.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 1. Findings. The General Assembly finds it is in
5		the best interests of the State to take advantage of the
6		Patient Protection and Affordable Care Act to enable Illinois
7		to receive enhanced federal revenue to cover the costs of
8		health care for low-income adults who are otherwise not
9		eligible for Medicaid. The General Assembly further finds that
10		the administration and financing of the Medicaid program must
11		be sound to ensure Illinois may take full advantage of national
12		health care reform to keep people healthier; reimburse
13		hospitals and clinics for uncompensated and charity care for
14		the uninsured; and replace spending by county and local
15		governments for healthcare costs now borne by local health
16		departments, social service agencies, homeless shelters,
17		mental health clinics, drug treatment centers, township
18		organizations, and others for the care of the uninsured.
19		Accordingly, the General Assembly finds that, while filling the
20		current gap in Medicaid coverage, it is essential that the
21		State preserve and extend recent efforts to reform Illinois'
22		Medicaid program. Changes designed to increase efficiencies
23		and enhance program integrity must continue to prevent client
24		and provider fraud and abuse; to impose controls on use of

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1		Medicaid services to prevent over-use or waste; to rationalize
2		the Medicaid health care delivery system by adopting care
3		coordination models wherever feasible to achieve effective and
4		efficient care delivery across all covered services; and to
5		operate the program within budget limits.
6		Section 5. The Illinois Public Aid Code is amended by
7		changing Sections 5-1.1, 5-1.4, 5-2, 5A-2, 5A-4, 5A-5, 5A-8,
8		and 5A-12.4 as follows:
9		(305 ILCS 5/5-1.1) (from Ch. 23, par. 5-1.1)
10		Sec. 5-1.1. Definitions. The terms defined in this Section
11		shall have the meanings ascribed to them, except when the
12		context otherwise requires.
13		(a) "Nursing facility" means a facility, licensed by the
14		Department of Public Health under the Nursing Home Care Act,
15		that provides nursing facility services within the meaning of
16		Title XIX of the federal Social Security Act.
17		(b) "Intermediate care facility for the developmentally
18		disabled" or "ICF/DD" means a facility, licensed by the
19		Department of Public Health under the ID/DD Community Care Act,
20		that is an intermediate care facility for the mentally retarded
21		within the meaning of Title XIX of the federal Social Security
22		Act.
23		(c) "Standard services" means those services required for
24		the care of all patients in the facility and shall, as a

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1		minimum, include the following: (1) administration; (2)
2		dietary (standard); (3) housekeeping; (4) laundry and linen;
3		(5) maintenance of property and equipment, including
4		utilities; (6) medical records; (7) training of employees; (8)
5		utilization review; (9) activities services; (10) social
6		services; (11) disability services; and all other similar
7		services required by either the laws of the State of Illinois
8		or one of its political subdivisions or municipalities or by
9		Title XIX of the Social Security Act.
10		(d) "Patient services" means those which vary with the
11		number of personnel; professional and para-professional skills
12		of the personnel; specialized equipment, and reflect the
13		intensity of the medical and psycho-social needs of the
14		patients. Patient services shall as a minimum include: (1)
15		physical services; (2) nursing services, including restorative
16		nursing; (3) medical direction and patient care planning; (4)
17		health related supportive and habilitative services and all
18		similar services required by either the laws of the State of
19		Illinois or one of its political subdivisions or municipalities
20		or by Title XIX of the Social Security Act.
21		(e) "Ancillary services" means those services which
22		require a specific physician's order and defined as under the
23		medical assistance program as not being routine in nature for
24		skilled nursing facilities and ICF/DDs. Such services
25		generally must be authorized prior to delivery and payment as
26		provided for under the rules of the Department of Healthcare

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1		and Family Services.
2		(f) "Capital" means the investment in a facility's assets
3		for both debt and non-debt funds. Non-debt capital is the
4		difference between an adjusted replacement value of the assets
5		and the actual amount of debt capital.
6		(g) "Profit" means the amount which shall accrue to a
7		facility as a result of its revenues exceeding its expenses as
8		determined in accordance with generally accepted accounting
9		principles.
10		(h) "Non-institutional services" means those services
11		provided under paragraph (f) of Section 3 of the Disabled
12		Persons Rehabilitation Act and those services provided under
13		Section 4.02 of the Illinois Act on the Aging.
14		(i) (Blank).
15		(j) "Institutionalized person" means an individual who is
16		an inpatient in an ICF/DD or nursing facility, or who is an
17		inpatient in a medical institution receiving a level of care
18		equivalent to that of an ICF/DD or nursing facility, or who is
19		receiving services under Section 1915(c) of the Social Security
20		Act.
21		(k) "Institutionalized spouse" means an institutionalized
22		person who is expected to receive services at the same level of
23		care for at least 30 days and is married to a spouse who is not
24		an institutionalized person.
25		(l) "Community spouse" is the spouse of an
26		institutionalized spouse.

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1		(m) "Health Benefits Service Package" means, subject to
2		federal approval, benefits covered by the medical assistance
3		program as determined by the Department by rule for individuals
4		eligible for medical assistance under paragraph 18 of Section
5		5-2 of this Code.
6		(Source: P.A. 96-1530, eff. 2-16-11; 97-227, eff. 1-1-12;
7		97-820, eff. 7-17-12.)
8		(305 ILCS 5/5-1.4)
9		Sec. 5-1.4. Moratorium on eligibility expansions.
10		Beginning on January 25, 2011 (the effective date of Public Act
11		96-1501), there shall be a 4-year moratorium on the expansion
12		of eligibility through increasing financial eligibility
13		standards, or through increasing income disregards, or through
14		the creation of new programs which would add new categories of
15		eligible individuals under the medical assistance program in
16		addition to those categories covered on January 1, 2011 or
17		above the level of any subsequent reduction in eligibility.
18		This moratorium shall not apply to expansions required as a
19		federal condition of State participation in the medical
20		assistance program or to expansions approved by the federal
21		government that are financed entirely by units of local
22		government and federal matching funds. If the State of Illinois
23		finds that the State has borne a cost related to such an
24		expansion, the unit of local government shall reimburse the
25		State. All federal funds associated with an expansion funded by

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1		a unit of local government shall be returned to the local
2		government entity funding the expansion, pursuant to an
3		intergovernmental agreement between the Department of
4		Healthcare and Family Services and the local government entity.
5		Within 10 calendar days of the effective date of this
6		amendatory Act of the 97th General Assembly, the Department of
7		Healthcare and Family Services shall formally advise the
8		Centers for Medicare and Medicaid Services of the passage of
9		this amendatory Act of the 97th General Assembly. The State is
10		prohibited from submitting additional waiver requests that
11		expand or allow for an increase in the classes of persons
12		eligible for medical assistance under this Article to the
13		federal government for its consideration beginning on the 20th
14		calendar day following the effective date of this amendatory
15		Act of the 97th General Assembly until January 25, 2015. This
16		moratorium shall not apply to those persons eligible for
17		medical assistance pursuant to 42 U.S.C.
18		1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
19		Section 5-2 of this Code.
20		(Source: P.A. 96-1501, eff. 1-25-11; 97-687, eff. 6-14-12.)
21		(305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
22		Sec. 5-2. Classes of Persons Eligible. Medical assistance
23		under this Article shall be available to any of the following
24		classes of persons in respect to whom a plan for coverage has
25		been submitted to the Governor by the Illinois Department and

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1		approved by him:
2		1. Recipients of basic maintenance grants under
3		Articles III and IV.
4		2. Persons otherwise eligible for basic maintenance
5		under Articles III and IV, excluding any eligibility
6		requirements that are inconsistent with any federal law or
7		federal regulation, as interpreted by the U.S. Department
8		of Health and Human Services, but who fail to qualify
9		thereunder on the basis of need or who qualify but are not
10		receiving basic maintenance under Article IV, and who have
11		insufficient income and resources to meet the costs of
12		necessary medical care, including but not limited to the
13		following:
14		(a) All persons otherwise eligible for basic
15		maintenance under Article III but who fail to qualify
16		under that Article on the basis of need and who meet
17		either of the following requirements:
18		(i) their income, as determined by the
19		Illinois Department in accordance with any federal
20		requirements, is equal to or less than 70% in
21		fiscal year 2001, equal to or less than 85% in
22		fiscal year 2002 and until a date to be determined
23		by the Department by rule, and equal to or less
24		than 100% beginning on the date determined by the
25		Department by rule, of the nonfarm income official
26		poverty line, as defined by the federal Office of

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1		Management and Budget and revised annually in
2		accordance with Section 673(2) of the Omnibus
3		Budget Reconciliation Act of 1981, applicable to
4		families of the same size; or
5		(ii) their income, after the deduction of
6		costs incurred for medical care and for other types
7		of remedial care, is equal to or less than 70% in
8		fiscal year 2001, equal to or less than 85% in
9		fiscal year 2002 and until a date to be determined
10		by the Department by rule, and equal to or less
11		than 100% beginning on the date determined by the
12		Department by rule, of the nonfarm income official
13		poverty line, as defined in item (i) of this
14		subparagraph (a).
15		(b) All persons who, excluding any eligibility
16		requirements that are inconsistent with any federal
17		law or federal regulation, as interpreted by the U.S.
18		Department of Health and Human Services, would be
19		determined eligible for such basic maintenance under
20		Article IV by disregarding the maximum earned income
21		permitted by federal law.
22		3. Persons who would otherwise qualify for Aid to the
23		Medically Indigent under Article VII.
24		4. Persons not eligible under any of the preceding
25		paragraphs who fall sick, are injured, or die, not having
26		sufficient money, property or other resources to meet the

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1		costs of necessary medical care or funeral and burial
2		expenses.
3		5.(a) Women during pregnancy, after the fact of
4		pregnancy has been determined by medical diagnosis, and
5		during the 60-day period beginning on the last day of the
6		pregnancy, together with their infants and children born
7		after September 30, 1983, whose income and resources are
8		insufficient to meet the costs of necessary medical care to
9		the maximum extent possible under Title XIX of the Federal
10		Social Security Act.
11		(b) The Illinois Department and the Governor shall
12		provide a plan for coverage of the persons eligible under
13		paragraph 5(a) by April 1, 1990. Such plan shall provide
14		ambulatory prenatal care to pregnant women during a
15		presumptive eligibility period and establish an income
16		eligibility standard that is equal to 133% of the nonfarm
17		income official poverty line, as defined by the federal
18		Office of Management and Budget and revised annually in
19		accordance with Section 673(2) of the Omnibus Budget
20		Reconciliation Act of 1981, applicable to families of the
21		same size, provided that costs incurred for medical care
22		are not taken into account in determining such income
23		eligibility.
24		(c) The Illinois Department may conduct a
25		demonstration in at least one county that will provide
26		medical assistance to pregnant women, together with their

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1		infants and children up to one year of age, where the
2		income eligibility standard is set up to 185% of the
3		nonfarm income official poverty line, as defined by the
4		federal Office of Management and Budget. The Illinois
5		Department shall seek and obtain necessary authorization
6		provided under federal law to implement such a
7		demonstration. Such demonstration may establish resource
8		standards that are not more restrictive than those
9		established under Article IV of this Code.
10		6. Persons under the age of 18 who fail to qualify as
11		dependent under Article IV and who have insufficient income
12		and resources to meet the costs of necessary medical care
13		to the maximum extent permitted under Title XIX of the
14		Federal Social Security Act.
15		7. (Blank).
16		8. Persons who become ineligible for basic maintenance
17		assistance under Article IV of this Code in programs
18		administered by the Illinois Department due to employment
19		earnings and persons in assistance units comprised of
20		adults and children who become ineligible for basic
21		maintenance assistance under Article VI of this Code due to
22		employment earnings. The plan for coverage for this class
23		of persons shall:
24		(a) extend the medical assistance coverage for up
25		to 12 months following termination of basic
26		maintenance assistance; and

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1		(b) offer persons who have initially received 6
2		months of the coverage provided in paragraph (a) above,
3		the option of receiving an additional 6 months of
4		coverage, subject to the following:
5		(i) such coverage shall be pursuant to
6		provisions of the federal Social Security Act;
7		(ii) such coverage shall include all services
8		covered while the person was eligible for basic
9		maintenance assistance;
10		(iii) no premium shall be charged for such
11		coverage; and
12		(iv) such coverage shall be suspended in the
13		event of a person's failure without good cause to
14		file in a timely fashion reports required for this
15		coverage under the Social Security Act and
16		coverage shall be reinstated upon the filing of
17		such reports if the person remains otherwise
18		eligible.
19		9. Persons with acquired immunodeficiency syndrome
20		(AIDS) or with AIDS-related conditions with respect to whom
21		there has been a determination that but for home or
22		community-based services such individuals would require
23		the level of care provided in an inpatient hospital,
24		skilled nursing facility or intermediate care facility the
25		cost of which is reimbursed under this Article. Assistance
26		shall be provided to such persons to the maximum extent

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1		permitted under Title XIX of the Federal Social Security
2		Act.
3		10. Participants in the long-term care insurance
4		partnership program established under the Illinois
5		Long-Term Care Partnership Program Act who meet the
6		qualifications for protection of resources described in
7		Section 15 of that Act.
8		11. Persons with disabilities who are employed and
9		eligible for Medicaid, pursuant to Section
10		1902(a)(10)(A)(ii)(xv) of the Social Security Act, and,
11		subject to federal approval, persons with a medically
12		improved disability who are employed and eligible for
13		Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of
14		the Social Security Act, as provided by the Illinois
15		Department by rule. In establishing eligibility standards
16		under this paragraph 11, the Department shall, subject to
17		federal approval:
18		(a) set the income eligibility standard at not
19		lower than 350% of the federal poverty level;
20		(b) exempt retirement accounts that the person
21		cannot access without penalty before the age of 59 1/2,
22		and medical savings accounts established pursuant to
23		26 U.S.C. 220;
24		(c) allow non-exempt assets up to $25,000 as to
25		those assets accumulated during periods of eligibility
26		under this paragraph 11; and

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1		(d) continue to apply subparagraphs (b) and (c) in
2		determining the eligibility of the person under this
3		Article even if the person loses eligibility under this
4		paragraph 11.
5		12. Subject to federal approval, persons who are
6		eligible for medical assistance coverage under applicable
7		provisions of the federal Social Security Act and the
8		federal Breast and Cervical Cancer Prevention and
9		Treatment Act of 2000. Those eligible persons are defined
10		to include, but not be limited to, the following persons:
11		(1) persons who have been screened for breast or
12		cervical cancer under the U.S. Centers for Disease
13		Control and Prevention Breast and Cervical Cancer
14		Program established under Title XV of the federal
15		Public Health Services Act in accordance with the
16		requirements of Section 1504 of that Act as
17		administered by the Illinois Department of Public
18		Health; and
19		(2) persons whose screenings under the above
20		program were funded in whole or in part by funds
21		appropriated to the Illinois Department of Public
22		Health for breast or cervical cancer screening.
23		"Medical assistance" under this paragraph 12 shall be
24		identical to the benefits provided under the State's
25		approved plan under Title XIX of the Social Security Act.
26		The Department must request federal approval of the

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1		coverage under this paragraph 12 within 30 days after the
2		effective date of this amendatory Act of the 92nd General
3		Assembly.
4		In addition to the persons who are eligible for medical
5		assistance pursuant to subparagraphs (1) and (2) of this
6		paragraph 12, and to be paid from funds appropriated to the
7		Department for its medical programs, any uninsured person
8		as defined by the Department in rules residing in Illinois
9		who is younger than 65 years of age, who has been screened
10		for breast and cervical cancer in accordance with standards
11		and procedures adopted by the Department of Public Health
12		for screening, and who is referred to the Department by the
13		Department of Public Health as being in need of treatment
14		for breast or cervical cancer is eligible for medical
15		assistance benefits that are consistent with the benefits
16		provided to those persons described in subparagraphs (1)
17		and (2). Medical assistance coverage for the persons who
18		are eligible under the preceding sentence is not dependent
19		on federal approval, but federal moneys may be used to pay
20		for services provided under that coverage upon federal
21		approval.
22		13. Subject to appropriation and to federal approval,
23		persons living with HIV/AIDS who are not otherwise eligible
24		under this Article and who qualify for services covered
25		under Section 5-5.04 as provided by the Illinois Department
26		by rule.

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1		14. Subject to the availability of funds for this
2		purpose, the Department may provide coverage under this
3		Article to persons who reside in Illinois who are not
4		eligible under any of the preceding paragraphs and who meet
5		the income guidelines of paragraph 2(a) of this Section and
6		(i) have an application for asylum pending before the
7		federal Department of Homeland Security or on appeal before
8		a court of competent jurisdiction and are represented
9		either by counsel or by an advocate accredited by the
10		federal Department of Homeland Security and employed by a
11		not-for-profit organization in regard to that application
12		or appeal, or (ii) are receiving services through a
13		federally funded torture treatment center. Medical
14		coverage under this paragraph 14 may be provided for up to
15		24 continuous months from the initial eligibility date so
16		long as an individual continues to satisfy the criteria of
17		this paragraph 14. If an individual has an appeal pending
18		regarding an application for asylum before the Department
19		of Homeland Security, eligibility under this paragraph 14
20		may be extended until a final decision is rendered on the
21		appeal. The Department may adopt rules governing the
22		implementation of this paragraph 14.
23		15. Family Care Eligibility.
24		(a) On and after July 1, 2012, a caretaker relative
25		who is 19 years of age or older when countable income
26		is at or below 133% of the Federal Poverty Level

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1		Guidelines, as published annually in the Federal
2		Register, for the appropriate family size. A person may
3		not spend down to become eligible under this paragraph
4		15.
5		(b) Eligibility shall be reviewed annually.
6		(c) (Blank).
7		(d) (Blank).
8		(e) (Blank).
9		(f) (Blank).
10		(g) (Blank).
11		(h) (Blank).
12		(i) Following termination of an individual's
13		coverage under this paragraph 15, the individual must
14		be determined eligible before the person can be
15		re-enrolled.
16		16. Subject to appropriation, uninsured persons who
17		are not otherwise eligible under this Section who have been
18		certified and referred by the Department of Public Health
19		as having been screened and found to need diagnostic
20		evaluation or treatment, or both diagnostic evaluation and
21		treatment, for prostate or testicular cancer. For the
22		purposes of this paragraph 16, uninsured persons are those
23		who do not have creditable coverage, as defined under the
24		Health Insurance Portability and Accountability Act, or
25		have otherwise exhausted any insurance benefits they may
26		have had, for prostate or testicular cancer diagnostic

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1		evaluation or treatment, or both diagnostic evaluation and
2		treatment. To be eligible, a person must furnish a Social
3		Security number. A person's assets are exempt from
4		consideration in determining eligibility under this
5		paragraph 16. Such persons shall be eligible for medical
6		assistance under this paragraph 16 for so long as they need
7		treatment for the cancer. A person shall be considered to
8		need treatment if, in the opinion of the person's treating
9		physician, the person requires therapy directed toward
10		cure or palliation of prostate or testicular cancer,
11		including recurrent metastatic cancer that is a known or
12		presumed complication of prostate or testicular cancer and
13		complications resulting from the treatment modalities
14		themselves. Persons who require only routine monitoring
15		services are not considered to need treatment. "Medical
16		assistance" under this paragraph 16 shall be identical to
17		the benefits provided under the State's approved plan under
18		Title XIX of the Social Security Act. Notwithstanding any
19		other provision of law, the Department (i) does not have a
20		claim against the estate of a deceased recipient of
21		services under this paragraph 16 and (ii) does not have a
22		lien against any homestead property or other legal or
23		equitable real property interest owned by a recipient of
24		services under this paragraph 16.
25		17. Persons who, pursuant to a waiver approved by the
26		Secretary of the U.S. Department of Health and Human

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1		Services, are eligible for medical assistance under Title
2		XIX or XXI of the federal Social Security Act.
3		Notwithstanding any other provision of this Code and
4		consistent with the terms of the approved waiver, the
5		Illinois Department, may by rule:
6		(a) Limit the geographic areas in which the waiver
7		program operates.
8		(b) Determine the scope, quantity, duration, and
9		quality, and the rate and method of reimbursement, of
10		the medical services to be provided, which may differ
11		from those for other classes of persons eligible for
12		assistance under this Article.
13		(c) Restrict the persons' freedom in choice of
14		providers.
15		18. Beginning January 1, 2014, persons aged 19 or
16		older, but younger than 65, who are not otherwise eligible
17		for medical assistance under this Section 5-2, who qualify
18		for medical assistance pursuant to 42 U.S.C.
19		1396a(a)(10)(A)(i)(VIII) and as set forth in 42 CFR
20		435.119, and who have income at or below 133% of the
21		federal poverty level plus 5% for the applicable family
22		size as determined pursuant to 42 U.S.C. 1396a(e)(14) and
23		as set forth in 42 CFR 435.603. Persons eligible for
24		medical assistance under this paragraph 18 shall receive
25		coverage for the Health Benefits Service Package as that
26		term is defined in subsection (m) of Section 5-1.1 of this

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1		Code. If Illinois' federal medical assistance percentage
2		(FMAP) is reduced below 90% for persons eligible for
3		medical assistance under this paragraph 18, eligibility
4		under this paragraph 18 shall cease no later than the end
5		of the third month following the month in which the
6		reduction in FMAP takes effect.
7		In implementing the provisions of Public Act 96-20, the
8		Department is authorized to adopt only those rules necessary,
9		including emergency rules. Nothing in Public Act 96-20 permits
10		the Department to adopt rules or issue a decision that expands
11		eligibility for the FamilyCare Program to a person whose income
12		exceeds 185% of the Federal Poverty Level as determined from
13		time to time by the U.S. Department of Health and Human
14		Services, unless the Department is provided with express
15		statutory authority.
16		The Illinois Department and the Governor shall provide a
17		plan for coverage of the persons eligible under paragraph 7 as
18		soon as possible after July 1, 1984.
19		The eligibility of any such person for medical assistance
20		under this Article is not affected by the payment of any grant
21		under the Senior Citizens and Disabled Persons Property Tax
22		Relief Act or any distributions or items of income described
23		under subparagraph (X) of paragraph (2) of subsection (a) of
24		Section 203 of the Illinois Income Tax Act. The Department
25		shall by rule establish the amounts of assets to be disregarded
26		in determining eligibility for medical assistance, which shall

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1		at a minimum equal the amounts to be disregarded under the
2		Federal Supplemental Security Income Program. The amount of
3		assets of a single person to be disregarded shall not be less
4		than $2,000, and the amount of assets of a married couple to be
5		disregarded shall not be less than $3,000.
6		To the extent permitted under federal law, any person found
7		guilty of a second violation of Article VIIIA shall be
8		ineligible for medical assistance under this Article, as
9		provided in Section 8A-8.
10		The eligibility of any person for medical assistance under
11		this Article shall not be affected by the receipt by the person
12		of donations or benefits from fundraisers held for the person
13		in cases of serious illness, as long as neither the person nor
14		members of the person's family have actual control over the
15		donations or benefits or the disbursement of the donations or
16		benefits.
17		Notwithstanding any other provision of this Code, if the
18		United States Supreme Court holds Title II, Subtitle A, Section
19		2001(a) of Public Law 111-148 to be unconstitutional, or if a
20		holding of Public Law 111-148 makes Medicaid eligibility
21		allowed under Section 2001(a) inoperable, the State or a unit
22		of local government shall be prohibited from enrolling
23		individuals in the Medical Assistance Program as the result of
24		federal approval of a State Medicaid waiver on or after the
25		effective date of this amendatory Act of the 97th General
26		Assembly, and any individuals enrolled in the Medical

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1		Assistance Program pursuant to eligibility permitted as a
2		result of such a State Medicaid waiver shall become immediately
3		ineligible.
4		Notwithstanding any other provision of this Code, if an Act
5		of Congress that becomes a Public Law eliminates Section
6		2001(a) of Public Law 111-148, the State or a unit of local
7		government shall be prohibited from enrolling individuals in
8		the Medical Assistance Program as the result of federal
9		approval of a State Medicaid waiver on or after the effective
10		date of this amendatory Act of the 97th General Assembly, and
11		any individuals enrolled in the Medical Assistance Program
12		pursuant to eligibility permitted as a result of such a State
13		Medicaid waiver shall become immediately ineligible.
14		(Source: P.A. 96-20, eff. 6-30-09; 96-181, eff. 8-10-09;
15		96-328, eff. 8-11-09; 96-567, eff. 1-1-10; 96-1000, eff.
16		7-2-10; 96-1123, eff. 1-1-11; 96-1270, eff. 7-26-10; 97-48,
17		eff. 6-28-11; 97-74, eff. 6-30-11; 97-333, eff. 8-12-11;
18		97-687, eff. 6-14-12; 97-689, eff. 6-14-12; 97-813, eff.
19		7-13-12; revised 7-23-12.)
20		(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
21		(Section scheduled to be repealed on January 1, 2015)
22		Sec. 5A-2. Assessment.
23		(a) Subject to Sections 5A-3 and 5A-10, for State fiscal
24		years 2009 through 2014, and from July 1, 2014 through December
25		31, 2014, an annual assessment on inpatient services is imposed

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1		on each hospital provider in an amount equal to $218.38
2		multiplied by the difference of the hospital's occupied bed
3		days less the hospital's Medicare bed days.
4		For State fiscal years 2009 through 2014, and after a
5		hospital's occupied bed days and Medicare bed days shall be
6		determined using the most recent data available from each
7		hospital's 2005 Medicare cost report as contained in the
8		Healthcare Cost Report Information System file, for the quarter
9		ending on December 31, 2006, without regard to any subsequent
10		adjustments or changes to such data. If a hospital's 2005
11		Medicare cost report is not contained in the Healthcare Cost
12		Report Information System, then the Illinois Department may
13		obtain the hospital provider's occupied bed days and Medicare
14		bed days from any source available, including, but not limited
15		to, records maintained by the hospital provider, which may be
16		inspected at all times during business hours of the day by the
17		Illinois Department or its duly authorized agents and
18		employees.
19		(b) (Blank).
20		(b-5) Subject to Sections 5A-3 and 5A-10, for the portion
21		of State fiscal year 2012, beginning June 10, 2012 through June
22		30, 2012, and for State fiscal years 2013 through 2014, and
23		July 1, 2014 through December 31, 2014, an annual assessment on
24		outpatient services is imposed on each hospital provider in an
25		amount equal to .008766 multiplied by the hospital's outpatient
26		gross revenue. For the period beginning June 10, 2012 through

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1		June 30, 2012, the annual assessment on outpatient services
2		shall be prorated by multiplying the assessment amount by a
3		fraction, the numerator of which is 21 days and the denominator
4		of which is 365 days.
5		For the portion of State fiscal year 2012, beginning June
6		10, 2012 through June 30, 2012, and State fiscal years 2013
7		through 2014, and July 1, 2014 through December 31, 2014, a
8		hospital's outpatient gross revenue shall be determined using
9		the most recent data available from each hospital's 2009
10		Medicare cost report as contained in the Healthcare Cost Report
11		Information System file, for the quarter ending on June 30,
12		2011, without regard to any subsequent adjustments or changes
13		to such data. If a hospital's 2009 Medicare cost report is not
14		contained in the Healthcare Cost Report Information System,
15		then the Department may obtain the hospital provider's
16		outpatient gross revenue from any source available, including,
17		but not limited to, records maintained by the hospital
18		provider, which may be inspected at all times during business
19		hours of the day by the Department or its duly authorized
20		agents and employees.
21		(c) (Blank).
22		(d) Notwithstanding any of the other provisions of this
23		Section, the Department is authorized to adopt rules to reduce
24		the rate of any annual assessment imposed under this Section,
25		as authorized by Section 5-46.2 of the Illinois Administrative
26		Procedure Act.

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1		(e) Notwithstanding any other provision of this Section,
2		any plan providing for an assessment on a hospital provider as
3		a permissible tax under Title XIX of the federal Social
4		Security Act and Medicaid-eligible payments to hospital
5		providers from the revenues derived from that assessment shall
6		be reviewed by the Illinois Department of Healthcare and Family
7		Services, as the Single State Medicaid Agency required by
8		federal law, to determine whether those assessments and
9		hospital provider payments meet federal Medicaid standards. If
10		the Department determines that the elements of the plan may
11		meet federal Medicaid standards and a related State Medicaid
12		Plan Amendment is prepared in a manner and form suitable for
13		submission, that State Plan Amendment shall be submitted in a
14		timely manner for review by the Centers for Medicare and
15		Medicaid Services of the United States Department of Health and
16		Human Services and subject to approval by the Centers for
17		Medicare and Medicaid Services of the United States Department
18		of Health and Human Services. No such plan shall become
19		effective without approval by the Illinois General Assembly by
20		the enactment into law of related legislation. Notwithstanding
21		any other provision of this Section, the Department is
22		authorized to adopt rules to reduce the rate of any annual
23		assessment imposed under this Section. Any such rules may be
24		adopted by the Department under Section 5-50 of the Illinois
25		Administrative Procedure Act.
26		(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;

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1		97-689, eff. 6-14-12.)
2		(305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4)
3		Sec. 5A-4. Payment of assessment; penalty.
4		(a) The assessment imposed by Section 5A-2 for State fiscal
5		year 2009 and each subsequent State fiscal year shall be due
6		and payable in monthly installments, each equaling one-twelfth
7		of the assessment for the year, on the fourteenth State
8		business day of each month. No installment payment of an
9		assessment imposed by Section 5A-2 shall be due and payable,
10		however, until after the Comptroller has issued the payments
11		required under this Article.
12		Except as provided in subsection (a-5) of this Section, the
13		assessment imposed by subsection (b-5) of Section 5A-2 for the
14		portion of State fiscal year 2012 beginning June 10, 2012
15		through June 30, 2012, and for State fiscal year 2013 and each
16		subsequent State fiscal year shall be due and payable in
17		monthly installments, each equaling one-twelfth of the
18		assessment for the year, on the 14th State business day of each
19		month. No installment payment of an assessment imposed by
20		subsection (b-5) of Section 5A-2 shall be due and payable,
21		however, until after: (i) the Department notifies the hospital
22		provider, in writing, that the payment methodologies to
23		hospitals required under Section 5A-12.4, have been approved by
24		the Centers for Medicare and Medicaid Services of the U.S.
25		Department of Health and Human Services, and the waiver under

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1		42 CFR 433.68 for the assessment imposed by subsection (b-5) of
2		Section 5A-2, if necessary, has been granted by the Centers for
3		Medicare and Medicaid Services of the U.S. Department of Health
4		and Human Services; and (ii) the Comptroller has issued the
5		payments required under Section 5A-12.4. Upon notification to
6		the Department of approval of the payment methodologies
7		required under Section 5A-12.4 and the waiver granted under 42
8		CFR 433.68, if necessary, all installments otherwise due under
9		subsection (b-5) of Section 5A-2 prior to the date of
10		notification shall be due and payable to the Department upon
11		written direction from the Department and issuance by the
12		Comptroller of the payments required under Section 5A-12.4.
13		(a-5) The Illinois Department may accelerate the schedule
14		upon which assessment installments are due and payable by
15		hospitals with a payment ratio greater than or equal to one.
16		Such acceleration of due dates for payment of the assessment
17		may be made only in conjunction with a corresponding
18		acceleration in access payments identified in Section 5A-12.2
19		or Section 5A-12.4 to the same hospitals. For the purposes of
20		this subsection (a-5), a hospital's payment ratio is defined as
21		the quotient obtained by dividing the total payments for the
22		State fiscal year, as authorized under Section 5A-12.2 or
23		Section 5A-12.4, by the total assessment for the State fiscal
24		year imposed under Section 5A-2 or subsection (b-5) of Section
25		5A-2.
26		(b) The Illinois Department is authorized to establish

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1		delayed payment schedules for hospital providers that are
2		unable to make installment payments when due under this Section
3		due to financial difficulties, as determined by the Illinois
4		Department.
5		(c) If a hospital provider fails to pay the full amount of
6		an installment when due (including any extensions granted under
7		subsection (b)), there shall, unless waived by the Illinois
8		Department for reasonable cause, be added to the assessment
9		imposed by Section 5A-2 a penalty assessment equal to the
10		lesser of (i) 5% of the amount of the installment not paid on
11		or before the due date plus 5% of the portion thereof remaining
12		unpaid on the last day of each 30-day period thereafter or (ii)
13		100% of the installment amount not paid on or before the due
14		date. For purposes of this subsection, payments will be
15		credited first to unpaid installment amounts (rather than to
16		penalty or interest), beginning with the most delinquent
17		installments.
18		(d) Any assessment amount that is due and payable to the
19		Illinois Department more frequently than once per calendar
20		quarter shall be remitted to the Illinois Department by the
21		hospital provider by means of electronic funds transfer. The
22		Illinois Department may provide for remittance by other means
23		if (i) the amount due is less than $10,000 or (ii) electronic
24		funds transfer is unavailable for this purpose.
25		(Source: P.A. 96-821, eff. 11-20-09; 97-688, eff. 6-14-12;
26		97-689, eff. 6-14-12.)

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1		(305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5)
2		Sec. 5A-5. Notice; penalty; maintenance of records.
3		(a) The Illinois Department shall send a notice of
4		assessment to every hospital provider subject to assessment
5		under this Article. The notice of assessment shall notify the
6		hospital of its assessment and shall be sent after receipt by
7		the Department of notification from the Centers for Medicare
8		and Medicaid Services of the U.S. Department of Health and
9		Human Services that the payment methodologies required under
10		this Article and, if necessary, the waiver granted under 42 CFR
11		433.68 have been approved. The notice shall be on a form
12		prepared by the Illinois Department and shall state the
13		following:
14		(1) The name of the hospital provider.
15		(2) The address of the hospital provider's principal
16		place of business from which the provider engages in the
17		occupation of hospital provider in this State, and the name
18		and address of each hospital operated, conducted, or
19		maintained by the provider in this State.
20		(3) The occupied bed days, occupied bed days less
21		Medicare days, adjusted gross hospital revenue, or
22		outpatient gross revenue of the hospital provider
23		(whichever is applicable), the amount of assessment
24		imposed under Section 5A-2 for the State fiscal year for
25		which the notice is sent, and the amount of each

SB0026 Engrossed - 29 - LRB098 05310 KTG 35344 b
1		installment to be paid during the State fiscal year.
2		(4) (Blank).
3		(5) Other reasonable information as determined by the
4		Illinois Department.
5		(b) If a hospital provider conducts, operates, or maintains
6		more than one hospital licensed by the Illinois Department of
7		Public Health, the provider shall pay the assessment for each
8		hospital separately.
9		(c) Notwithstanding any other provision in this Article, in
10		the case of a person who ceases to conduct, operate, or
11		maintain a hospital in respect of which the person is subject
12		to assessment under this Article as a hospital provider, the
13		assessment for the State fiscal year in which the cessation
14		occurs shall be adjusted by multiplying the assessment computed
15		under Section 5A-2 by a fraction, the numerator of which is the
16		number of days in the year during which the provider conducts,
17		operates, or maintains the hospital and the denominator of
18		which is 365. Immediately upon ceasing to conduct, operate, or
19		maintain a hospital, the person shall pay the assessment for
20		the year as so adjusted (to the extent not previously paid).
21		(d) Notwithstanding any other provision in this Article, a
22		provider who commences conducting, operating, or maintaining a
23		hospital, upon notice by the Illinois Department, shall pay the
24		assessment computed under Section 5A-2 and subsection (e) in
25		installments on the due dates stated in the notice and on the
26		regular installment due dates for the State fiscal year

SB0026 Engrossed - 30 - LRB098 05310 KTG 35344 b
1		occurring after the due dates of the initial notice.
2		(e) Notwithstanding any other provision in this Article,
3		for State fiscal years 2009 through 2015, in the case of a
4		hospital provider that did not conduct, operate, or maintain a
5		hospital in 2005, the assessment for that State fiscal year
6		shall be computed on the basis of hypothetical occupied bed
7		days for the full calendar year as determined by the Illinois
8		Department. Notwithstanding any other provision in this
9		Article, for the portion of State fiscal year 2012 beginning
10		June 10, 2012 through June 30, 2012, and for State fiscal years
11		2013 through 2014, and for July 1, 2014 through December 31,
12		2014, in the case of a hospital provider that did not conduct,
13		operate, or maintain a hospital in 2009, the assessment under
14		subsection (b-5) of Section 5A-2 for that State fiscal year
15		shall be computed on the basis of hypothetical gross outpatient
16		revenue for the full calendar year as determined by the
17		Illinois Department.
18		(f) Every hospital provider subject to assessment under
19		this Article shall keep sufficient records to permit the
20		determination of adjusted gross hospital revenue for the
21		hospital's fiscal year. All such records shall be kept in the
22		English language and shall, at all times during regular
23		business hours of the day, be subject to inspection by the
24		Illinois Department or its duly authorized agents and
25		employees.
26		(g) The Illinois Department may, by rule, provide a

SB0026 Engrossed - 31 - LRB098 05310 KTG 35344 b
1		hospital provider a reasonable opportunity to request a
2		clarification or correction of any clerical or computational
3		errors contained in the calculation of its assessment, but such
4		corrections shall not extend to updating the cost report
5		information used to calculate the assessment.
6		(h) (Blank).
7		(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
8		97-689, eff. 6-14-12; revised 10-17-12.)
9		(305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
10		Sec. 5A-8. Hospital Provider Fund.
11		(a) There is created in the State Treasury the Hospital
12		Provider Fund. Interest earned by the Fund shall be credited to
13		the Fund. The Fund shall not be used to replace any moneys
14		appropriated to the Medicaid program by the General Assembly.
15		(b) The Fund is created for the purpose of receiving moneys
16		in accordance with Section 5A-6 and disbursing moneys only for
17		the following purposes, notwithstanding any other provision of
18		law:
19		(1) For making payments to hospitals as required under
20		this Code, under the Children's Health Insurance Program
21		Act, under the Covering ALL KIDS Health Insurance Act, and
22		under the Long Term Acute Care Hospital Quality Improvement
23		Transfer Program Act.
24		(2) For the reimbursement of moneys collected by the
25		Illinois Department from hospitals or hospital providers

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1		through error or mistake in performing the activities
2		authorized under this Code.
3		(3) For payment of administrative expenses incurred by
4		the Illinois Department or its agent in performing
5		activities under this Code, under the Children's Health
6		Insurance Program Act, under the Covering ALL KIDS Health
7		Insurance Act, and under the Long Term Acute Care Hospital
8		Quality Improvement Transfer Program Act.
9		(4) For payments of any amounts which are reimbursable
10		to the federal government for payments from this Fund which
11		are required to be paid by State warrant.
12		(5) For making transfers, as those transfers are
13		authorized in the proceedings authorizing debt under the
14		Short Term Borrowing Act, but transfers made under this
15		paragraph (5) shall not exceed the principal amount of debt
16		issued in anticipation of the receipt by the State of
17		moneys to be deposited into the Fund.
18		(6) For making transfers to any other fund in the State
19		treasury, but transfers made under this paragraph (6) shall
20		not exceed the amount transferred previously from that
21		other fund into the Hospital Provider Fund plus any
22		interest that would have been earned by that fund on the
23		monies that had been transferred.
24		(6.5) For making transfers to the Healthcare Provider
25		Relief Fund, except that transfers made under this
26		paragraph (6.5) shall not exceed $60,000,000 in the

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1		aggregate.
2		(7) For making transfers not exceeding the following
3		amounts, in State fiscal years 2013 and 2014 in each State
4		fiscal year during which an assessment is imposed pursuant
5		to Section 5A-2, to the following designated funds:
6		Health and Human Services Medicaid Trust
7		Fund..............................$20,000,000
8		Long-Term Care Provider Fund..........$30,000,000
9		General Revenue Fund.................$80,000,000.
10		Transfers under this paragraph shall be made within 7 days
11		after the payments have been received pursuant to the
12		schedule of payments provided in subsection (a) of Section
13		5A-4.
14		(7.1) For making transfers not exceeding the following
15		amounts, in State fiscal year 2015, to the following
16		designated funds:
17		Health and Human Services Medicaid Trust
18		Fund..............................$10,000,000
19		Long-Term Care Provider Fund..........$15,000,000
20		General Revenue Fund.................$40,000,000.
21		Transfers under this paragraph shall be made within 7 days
22		after the payments have been received pursuant to the
23		schedule of payments provided in subsection (a) of Section
24		5A-4.
25		(7.5) (Blank).
26		(7.8) (Blank).

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1		(7.9) (Blank).
2		(7.10) For State fiscal years 2013 and 2014, for making
3		transfers of the moneys resulting from the assessment under
4		subsection (b-5) of Section 5A-2 and received from hospital
5		providers under Section 5A-4 and transferred into the
6		Hospital Provider Fund under Section 5A-6 to the designated
7		funds not exceeding the following amounts in that State
8		fiscal year:
9		Health Care Provider Relief Fund......$50,000,000
10		Transfers under this paragraph shall be made within 7
11		days after the payments have been received pursuant to the
12		schedule of payments provided in subsection (a) of Section
13		5A-4.
14		(7.11) For State fiscal year 2015, for making transfers
15		of the moneys resulting from the assessment under
16		subsection (b-5) of Section 5A-2 and received from hospital
17		providers under Section 5A-4 and transferred into the
18		Hospital Provider Fund under Section 5A-6 to the designated
19		funds not exceeding the following amounts in that State
20		fiscal year:
21		Health Care Provider Relief Fund.....$25,000,000
22		Transfers under this paragraph shall be made within 7
23		days after the payments have been received pursuant to the
24		schedule of payments provided in subsection (a) of Section
25		5A-4.
26		(7.12) For State fiscal year 2013, for increasing by

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1		21/365ths the transfer of the moneys resulting from the
2		assessment under subsection (b-5) of Section 5A-2 and
3		received from hospital providers under Section 5A-4 for the
4		portion of State fiscal year 2012 beginning June 10, 2012
5		through June 30, 2012 and transferred into the Hospital
6		Provider Fund under Section 5A-6 to the designated funds
7		not exceeding the following amounts in that State fiscal
8		year:
9		Health Care Provider Relief Fund.......$2,870,000
10		(8) For making refunds to hospital providers pursuant
11		to Section 5A-10.
12		Disbursements from the Fund, other than transfers
13		authorized under paragraphs (5) and (6) of this subsection,
14		shall be by warrants drawn by the State Comptroller upon
15		receipt of vouchers duly executed and certified by the Illinois
16		Department.
17		(c) The Fund shall consist of the following:
18		(1) All moneys collected or received by the Illinois
19		Department from the hospital provider assessment imposed
20		by this Article.
21		(2) All federal matching funds received by the Illinois
22		Department as a result of expenditures made by the Illinois
23		Department that are attributable to moneys deposited in the
24		Fund.
25		(3) Any interest or penalty levied in conjunction with
26		the administration of this Article.

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1		(4) Moneys transferred from another fund in the State
2		treasury.
3		(5) All other moneys received for the Fund from any
4		other source, including interest earned thereon.
5		(d) (Blank).
6		(Source: P.A. 96-3, eff. 2-27-09; 96-45, eff. 7-15-09; 96-821,
7		eff. 11-20-09; 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12;
8		97-689, eff. 6-14-12; revised 10-17-12.)
9		(305 ILCS 5/5A-12.4)
10		(Section scheduled to be repealed on January 1, 2015)
11		Sec. 5A-12.4. Hospital access improvement payments on or
12		after June 10, 2012 July 1, 2012.
13		(a) Hospital access improvement payments. To preserve and
14		improve access to hospital services, for hospital and physician
15		services rendered on or after June 10, 2012 July 1, 2012, the
16		Illinois Department shall, except for hospitals described in
17		subsection (b) of Section 5A-3, make payments to hospitals as
18		set forth in this Section. These payments shall be paid in 12
19		equal installments on or before the 7th State business day of
20		each month, except that no payment shall be due within 100 days
21		after the later of the date of notification of federal approval
22		of the payment methodologies required under this Section or any
23		waiver required under 42 CFR 433.68, at which time the sum of
24		amounts required under this Section prior to the date of
25		notification is due and payable. Payments under this Section

SB0026 Engrossed - 37 - LRB098 05310 KTG 35344 b
1		are not due and payable, however, until (i) the methodologies
2		described in this Section are approved by the federal
3		government in an appropriate State Plan amendment and (ii) the
4		assessment imposed under subsection (b-5) of Section 5A-2 of
5		this Article is determined to be a permissible tax under Title
6		XIX of the Social Security Act. The Illinois Department shall
7		take all actions necessary to implement the payments under this
8		Section effective June 10, 2012 July 1, 2012, including but not
9		limited to providing public notice pursuant to federal
10		requirements, the filing of a State Plan amendment, and the
11		adoption of administrative rules. For State fiscal year 2013,
12		payments under this Section shall be increased by 21/365ths.
13		The funding source for these additional payments shall be from
14		the increased assessment under subsection (b-5) of Section 5A-2
15		that was received from hospital providers under Section 5A-4
16		for the portion of State fiscal year 2012 beginning June 10,
17		2012 through June 30, 2012.
18		(a-5) Accelerated schedule. The Illinois Department may,
19		when practicable, accelerate the schedule upon which payments
20		authorized under this Section are made.
21		(b) Magnet and perinatal hospital adjustment. In addition
22		to rates paid for inpatient hospital services, the Department
23		shall pay to each Illinois general acute care hospital that, as
24		of August 25, 2011, was recognized as a Magnet hospital by the
25		American Nurses Credentialing Center and that, as of September
26		14, 2011, was designated as a level III perinatal center

SB0026 Engrossed - 38 - LRB098 05310 KTG 35344 b
1		amounts as follows:
2		(1) For hospitals with a case mix index equal to or
3		greater than the 80th percentile of case mix indices for
4		all Illinois hospitals, $470 for each Medicaid general
5		acute care inpatient day of care provided by the hospital
6		during State fiscal year 2009.
7		(2) For all other hospitals, $170 for each Medicaid
8		general acute care inpatient day of care provided by the
9		hospital during State fiscal year 2009.
10		(c) Trauma level II adjustment. In addition to rates paid
11		for inpatient hospital services, the Department shall pay to
12		each Illinois general acute care hospital that, as of July 1,
13		2011, was designated as a level II trauma center amounts as
14		follows:
15		(1) For hospitals with a case mix index equal to or
16		greater than the 50th percentile of case mix indices for
17		all Illinois hospitals, $470 for each Medicaid general
18		acute care inpatient day of care provided by the hospital
19		during State fiscal year 2009.
20		(2) For all other hospitals, $170 for each Medicaid
21		general acute care inpatient day of care provided by the
22		hospital during State fiscal year 2009.
23		(3) For the purposes of this adjustment, hospitals
24		located in the same city that alternate their trauma center
25		designation as defined in 89 Ill. Adm. Code 148.295(a)(2)
26		shall have the adjustment provided under this Section

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1		divided between the 2 hospitals.
2		(d) Dual-eligible adjustment. In addition to rates paid for
3		inpatient services, the Department shall pay each Illinois
4		general acute care hospital that had a ratio of crossover days
5		to total inpatient days for programs under Title XIX of the
6		Social Security Act administered by the Department (utilizing
7		information from 2009 paid claims) greater than 50%, and a case
8		mix index equal to or greater than the 75th percentile of case
9		mix indices for all Illinois hospitals, a rate of $400 for each
10		Medicaid inpatient day during State fiscal year 2009 including
11		crossover days.
12		(e) Medicaid volume adjustment. In addition to rates paid
13		for inpatient hospital services, the Department shall pay to
14		each Illinois general acute care hospital that provided more
15		than 10,000 Medicaid inpatient days of care in State fiscal
16		year 2009, has a Medicaid inpatient utilization rate of at
17		least 29.05% as calculated by the Department for the Rate Year
18		2011 Disproportionate Share determination, and is not eligible
19		for Medicaid Percentage Adjustment payments in rate year 2011
20		an amount equal to $135 for each Medicaid inpatient day of care
21		provided during State fiscal year 2009.
22		(f) Outpatient service adjustment. In addition to the rates
23		paid for outpatient hospital services, the Department shall pay
24		each Illinois hospital an amount at least equal to $100
25		multiplied by the hospital's outpatient ambulatory procedure
26		listing services (excluding categories 3B and 3C) and by the

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1		hospital's end stage renal disease treatment services provided
2		for State fiscal year 2009.
3		(g) Ambulatory service adjustment.
4		(1) In addition to the rates paid for outpatient
5		hospital services provided in the emergency department,
6		the Department shall pay each Illinois hospital an amount
7		equal to $105 multiplied by the hospital's outpatient
8		ambulatory procedure listing services for categories 3A,
9		3B, and 3C for State fiscal year 2009.
10		(2) In addition to the rates paid for outpatient
11		hospital services, the Department shall pay each Illinois
12		freestanding psychiatric hospital an amount equal to $200
13		multiplied by the hospital's ambulatory procedure listing
14		services for category 5A for State fiscal year 2009.
15		(h) Specialty hospital adjustment. In addition to the rates
16		paid for outpatient hospital services, the Department shall pay
17		each Illinois long term acute care hospital and each Illinois
18		hospital devoted exclusively to the treatment of cancer, an
19		amount equal to $700 multiplied by the hospital's outpatient
20		ambulatory procedure listing services and by the hospital's end
21		stage renal disease treatment services (including services
22		provided to individuals eligible for both Medicaid and
23		Medicare) provided for State fiscal year 2009.
24		(h-1) ER Safety Net Payments. In addition to rates paid for
25		outpatient services, the Department shall pay to each Illinois
26		general acute care hospital with an emergency room ratio equal

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1		to or greater than 55%, that is not eligible for Medicaid
2		percentage adjustments payments in rate year 2011, with a case
3		mix index equal to or greater than the 20th percentile, and
4		that is not designated as a trauma center by the Illinois
5		Department of Public Health on July 1, 2011, as follows:
6		(1) Each hospital with an emergency room ratio equal to
7		or greater than 74% shall receive a rate of $225 for each
8		outpatient ambulatory procedure listing and end-stage
9		renal disease treatment service provided for State fiscal
10		year 2009.
11		(2) For all other hospitals, $65 shall be paid for each
12		outpatient ambulatory procedure listing and end-stage
13		renal disease treatment service provided for State fiscal
14		year 2009.
15		(i) Physician supplemental adjustment. In addition to the
16		rates paid for physician services, the Department shall make an
17		adjustment payment for services provided by physicians as
18		follows:
19		(1) Physician services eligible for the adjustment
20		payment are those provided by physicians employed by or who
21		have a contract to provide services to patients of the
22		following hospitals: (i) Illinois general acute care
23		hospitals that provided at least 17,000 Medicaid inpatient
24		days of care in State fiscal year 2009 and are eligible for
25		Medicaid Percentage Adjustment Payments in rate year 2011;
26		and (ii) Illinois freestanding children's hospitals, as

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1		defined in 89 Ill. Adm. Code 149.50(c)(3)(A).
2		(2) The amount of the adjustment for each eligible
3		hospital under this subsection (i) shall be determined by
4		rule by the Department to spend a total pool of at least
5		$6,960,000 annually. This pool shall be allocated among the
6		eligible hospitals based on the difference between the
7		upper payment limit for what could have been paid under
8		Medicaid for physician services provided during State
9		fiscal year 2009 by physicians employed by or who had a
10		contract with the hospital and the amount that was paid
11		under Medicaid for such services, provided however, that in
12		no event shall physicians at any individual hospital
13		collectively receive an annual, aggregate adjustment in
14		excess of $435,000, except that any amount that is not
15		distributed to a hospital because of the upper payment
16		limit shall be reallocated among the remaining eligible
17		hospitals that are below the upper payment limitation, on a
18		proportionate basis.
19		(i-5) For any children's hospital which did not charge for
20		its services during the base period, the Department shall use
21		data supplied by the hospital to determine payments using
22		similar methodologies for freestanding children's hospitals
23		under this Section or Section 5A-12.2 12.2.
24		(j) For purposes of this Section, a hospital that is
25		enrolled to provide Medicaid services during State fiscal year
26		2009 shall have its utilization and associated reimbursements

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1		annualized prior to the payment calculations being performed
2		under this Section.
3		(k) For purposes of this Section, the terms "Medicaid
4		days", "ambulatory procedure listing services", and
5		"ambulatory procedure listing payments" do not include any
6		days, charges, or services for which Medicare or a managed care
7		organization reimbursed on a capitated basis was liable for
8		payment, except where explicitly stated otherwise in this
9		Section.
10		(l) Definitions. Unless the context requires otherwise or
11		unless provided otherwise in this Section, the terms used in
12		this Section for qualifying criteria and payment calculations
13		shall have the same meanings as those terms have been given in
14		the Illinois Department's administrative rules as in effect on
15		October 1, 2011. Other terms shall be defined by the Illinois
16		Department by rule.
17		As used in this Section, unless the context requires
18		otherwise:
19		"Case mix index" means, for a given hospital, the sum of
20		the per admission (DRG) relative weighting factors in effect on
21		January 1, 2005, for all general acute care admissions for
22		State fiscal year 2009, excluding Medicare crossover
23		admissions and transplant admissions reimbursed under 89 Ill.
24		Adm. Code 148.82, divided by the total number of general acute
25		care admissions for State fiscal year 2009, excluding Medicare
26		crossover admissions and transplant admissions reimbursed

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1		under 89 Ill. Adm. Code 148.82.
2		"Emergency room ratio" means, for a given hospital, a
3		fraction, the denominator of which is the number of the
4		hospital's outpatient ambulatory procedure listing and
5		end-stage renal disease treatment services provided for State
6		fiscal year 2009 and the numerator of which is the hospital's
7		outpatient ambulatory procedure listing services for
8		categories 3A, 3B, and 3C for State fiscal year 2009.
9		"Medicaid inpatient day" means, for a given hospital, the
10		sum of days of inpatient hospital days provided to recipients
11		of medical assistance under Title XIX of the federal Social
12		Security Act, excluding days for individuals eligible for
13		Medicare under Title XVIII of that Act (Medicaid/Medicare
14		crossover days), as tabulated from the Department's paid claims
15		data for admissions occurring during State fiscal year 2009
16		that was adjudicated by the Department through June 30, 2010.
17		"Outpatient ambulatory procedure listing services" means,
18		for a given hospital, ambulatory procedure listing services, as
19		described in 89 Ill. Adm. Code 148.140(b), provided to
20		recipients of medical assistance under Title XIX of the federal
21		Social Security Act, excluding services for individuals
22		eligible for Medicare under Title XVIII of the Act
23		(Medicaid/Medicare crossover days), as tabulated from the
24		Department's paid claims data for services occurring in State
25		fiscal year 2009 that were adjudicated by the Department
26		through September 2, 2010.

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1		"Outpatient end-stage renal disease treatment services"
2		means, for a given hospital, the services, as described in 89
3		Ill. Adm. Code 148.140(c), provided to recipients of medical
4		assistance under Title XIX of the federal Social Security Act,
5		excluding payments for individuals eligible for Medicare under
6		Title XVIII of the Act (Medicaid/Medicare crossover days), as
7		tabulated from the Department's paid claims data for services
8		occurring in State fiscal year 2009 that were adjudicated by
9		the Department through September 2, 2010.
10		(m) The Department may adjust payments made under this
11		Section 5A-12.4 to comply with federal law or regulations
12		regarding hospital-specific payment limitations on
13		government-owned or government-operated hospitals.
14		(n) Notwithstanding any of the other provisions of this
15		Section, the Department is authorized to adopt rules that
16		change the hospital access improvement payments specified in
17		this Section, but only to the extent necessary to conform to
18		any federally approved amendment to the Title XIX State plan.
19		Any such rules shall be adopted by the Department as authorized
20		by Section 5-50 of the Illinois Administrative Procedure Act.
21		Notwithstanding any other provision of law, any changes
22		implemented as a result of this subsection (n) shall be given
23		retroactive effect so that they shall be deemed to have taken
24		effect as of the effective date of this Section.
25		(o) The Department of Healthcare and Family Services must
26		submit a State Medicaid Plan Amendment to the Centers of

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1		Medicare and Medicaid Services to implement the payments under
2		this Section. within 30 days of the effective date of this Act.
3		(Source: P.A. 97-688, eff. 6-14-12; revised 8-3-12.)
4		Section 99. Effective date. This Act takes effect upon
5		becoming law.