Sen. Heather A. Steans
Filed: 2/5/2013
 
 


 




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1
AMENDMENT TO SENATE BILL 26 




2 AMENDMENT NO. ______. Amend Senate Bill 26 as follows:


3on page 2, line 7, by replacing "and 5-2" with "5-2, 5A-2, 
45A-4, 5A-5, 5A-8, and 5A-12.4"; and

5on page 21, immediately below line 18, by inserting the 
6following:

7 "(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
8 (Section scheduled to be repealed on January 1, 2015)
9 Sec. 5A-2. Assessment.


10 (a)
Subject to Sections 5A-3 and 5A-10, for State fiscal 
11years 2009 through 2014, and from July 1, 2014 through December 
1231, 2014, an annual assessment on inpatient services is imposed 
13on each hospital provider in an amount equal to $218.38 
14multiplied by the difference of the hospital's occupied bed 
15days less the hospital's Medicare bed days.
 
 
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1 For State fiscal years 2009 through 2014, and after a 
2hospital's occupied bed days and Medicare bed days shall be 
3determined using the most recent data available from each 
4hospital's 2005 Medicare cost report as contained in the 
5Healthcare Cost Report Information System file, for the quarter 
6ending on December 31, 2006, without regard to any subsequent 
7adjustments or changes to such data. If a hospital's 2005 
8Medicare cost report is not contained in the Healthcare Cost 
9Report Information System, then the Illinois Department may 
10obtain the hospital provider's occupied bed days and Medicare 
11bed days from any source available, including, but not limited 
12to, records maintained by the hospital provider, which may be 
13inspected at all times during business hours of the day by the 
14Illinois Department or its duly authorized agents and 
15employees. 
16 (b) (Blank).


17 (b-5) Subject to Sections 5A-3 and 5A-10, for the portion 
18of State fiscal year 2012, beginning June 10, 2012 through June 
1930, 2012, and for State fiscal years 2013 through 2014, and 
20July 1, 2014 through December 31, 2014, an annual assessment on 
21outpatient services is imposed on each hospital provider in an 
22amount equal to .008766 multiplied by the hospital's outpatient 
23gross revenue. For the period beginning June 10, 2012 through 
24June 30, 2012, the annual assessment on outpatient services 
25shall be prorated by multiplying the assessment amount by a 
26fraction, the numerator of which is 21 days and the denominator 
 
 
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1of which is 365 days. 
2 For the portion of State fiscal year 2012, beginning June 
310, 2012 through June 30, 2012, and State fiscal years 2013 
4through 2014, and July 1, 2014 through December 31, 2014, a 
5hospital's outpatient gross revenue shall be determined using 
6the most recent data available from each hospital's 2009 
7Medicare cost report as contained in the Healthcare Cost Report 
8Information System file, for the quarter ending on June 30, 
92011, without regard to any subsequent adjustments or changes 
10to such data. If a hospital's 2009 Medicare cost report is not 
11contained in the Healthcare Cost Report Information System, 
12then the Department may obtain the hospital provider's 
13outpatient gross revenue from any source available, including, 
14but not limited to, records maintained by the hospital 
15provider, which may be inspected at all times during business 
16hours of the day by the Department or its duly authorized 
17agents and employees. 
18 (c) (Blank).


19 (d) Notwithstanding any of the other provisions of this 
20Section, the Department is authorized to adopt rules to reduce 
21the rate of any annual assessment imposed under this Section, 
22as authorized by Section 5-46.2 of the Illinois Administrative 
23Procedure Act.

24 (e) Notwithstanding any other provision of this Section, 
25any plan providing for an assessment on a hospital provider as 
26a permissible tax under Title XIX of the federal Social 
 
 
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1Security Act and Medicaid-eligible payments to hospital 
2providers from the revenues derived from that assessment shall 
3be reviewed by the Illinois Department of Healthcare and Family 
4Services, as the Single State Medicaid Agency required by 
5federal law, to determine whether those assessments and 
6hospital provider payments meet federal Medicaid standards. If 
7the Department determines that the elements of the plan may 
8meet federal Medicaid standards and a related State Medicaid 
9Plan Amendment is prepared in a manner and form suitable for 
10submission, that State Plan Amendment shall be submitted in a 
11timely manner for review by the Centers for Medicare and 
12Medicaid Services of the United States Department of Health and 
13Human Services and subject to approval by the Centers for 
14Medicare and Medicaid Services of the United States Department 
15of Health and Human Services. No such plan shall become 
16effective without approval by the Illinois General Assembly by 
17the enactment into law of related legislation. Notwithstanding 
18any other provision of this Section, the Department is 
19authorized to adopt rules to reduce the rate of any annual 
20assessment imposed under this Section. Any such rules may be 
21adopted by the Department under Section 5-50 of the Illinois 
22Administrative Procedure Act. 
23(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; 
2497-689, eff. 6-14-12.)


25 (305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4)
 
 
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1 Sec. 5A-4. Payment of assessment; penalty.

2 (a) The assessment imposed by Section 5A-2 for State fiscal 
3year 2009 and each subsequent State fiscal year shall be due 
4and payable in monthly installments, each equaling one-twelfth 
5of the assessment for the year, on the fourteenth State 
6business day of each month.
No installment payment of an 
7assessment imposed by Section 5A-2 shall be due
and
payable, 
8however, until after the Comptroller has issued the payments 
9required under this Article.

10 Except as provided in subsection (a-5) of this Section, the 
11assessment imposed by subsection (b-5) of Section 5A-2 for the 
12portion of State fiscal year 2012 beginning June 10, 2012 
13through June 30, 2012, and for State fiscal year 2013 and each 
14subsequent State fiscal year shall be due and payable in 
15monthly installments, each equaling one-twelfth of the 
16assessment for the year, on the 14th State business day of each 
17month. No installment payment of an assessment imposed by 
18subsection (b-5) of Section 5A-2 shall be due and payable, 
19however, until after: (i) the Department notifies the hospital 
20provider, in writing, that the payment methodologies to 
21hospitals required under Section 5A-12.4, have been approved by 
22the Centers for Medicare and Medicaid Services of the U.S. 
23Department of Health and Human Services, and the waiver under 
2442 CFR 433.68 for the assessment imposed by subsection (b-5) of 
25Section 5A-2, if necessary, has been granted by the Centers for 
26Medicare and Medicaid Services of the U.S. Department of Health 
 
 
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1and Human Services; and (ii) the Comptroller has issued the 
2payments required under Section 5A-12.4. Upon notification to 
3the Department of approval of the payment methodologies 
4required under Section 5A-12.4 and the waiver granted under 42 
5CFR 433.68, if necessary, all installments otherwise due under 
6subsection (b-5) of Section 5A-2 prior to the date of 
7notification shall be due and payable to the Department upon 
8written direction from the Department and issuance by the 
9Comptroller of the payments required under Section 5A-12.4. 
10 (a-5) The Illinois Department may accelerate the schedule 
11upon which assessment installments are due and payable by 
12hospitals with a payment ratio greater than or equal to one. 
13Such acceleration of due dates for payment of the assessment 
14may be made only in conjunction with a corresponding 
15acceleration in access payments identified in Section 5A-12.2 
16or Section 5A-12.4 to the same hospitals. For the purposes of 
17this subsection (a-5), a hospital's payment ratio is defined as 
18the quotient obtained by dividing the total payments for the 
19State fiscal year, as authorized under Section 5A-12.2 or 
20Section 5A-12.4, by the total assessment for the State fiscal 
21year imposed under Section 5A-2 or subsection (b-5) of Section 
225A-2. 
23 (b) The Illinois Department is authorized to establish

24delayed payment schedules for hospital providers that are 
25unable
to make installment payments when due under this Section 
26due to
financial difficulties, as determined by the Illinois 
 
 
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1Department.

2 (c) If a hospital provider fails to pay the full amount of

3an installment when due (including any extensions granted under

4subsection (b)), there shall, unless waived by the Illinois

5Department for reasonable cause, be added to the assessment

6imposed by Section 5A-2 a penalty
assessment equal to the 
7lesser of (i) 5% of the amount of the
installment not paid on 
8or before the due date plus 5% of the
portion thereof remaining 
9unpaid on the last day of each 30-day period
thereafter or (ii) 
10100% of the installment amount not paid on or
before the due 
11date. For purposes of this subsection, payments
will be 
12credited first to unpaid installment amounts (rather than
to 
13penalty or interest), beginning with the most delinquent

14installments.

15 (d) Any assessment amount that is due and payable to the 
16Illinois Department more frequently than once per calendar 
17quarter shall be remitted to the Illinois Department by the 
18hospital provider by means of electronic funds transfer. The 
19Illinois Department may provide for remittance by other means 
20if (i) the amount due is less than $10,000 or (ii) electronic 
21funds transfer is unavailable for this purpose. 
22(Source: P.A. 96-821, eff. 11-20-09; 97-688, eff. 6-14-12; 
2397-689, eff. 6-14-12.)

24 (305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5)
25 Sec. 5A-5. Notice; penalty; maintenance of records.

 
 
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1 (a)
The Illinois Department shall send a
notice of 
2assessment to every hospital provider subject
to assessment 
3under this Article. The notice of assessment shall notify the 
4hospital of its assessment and shall be sent after receipt by 
5the Department of notification from the Centers for Medicare 
6and Medicaid Services of the U.S. Department of Health and 
7Human Services that the payment methodologies required under 
8this Article and, if necessary, the waiver granted under 42 CFR 
9433.68 have been approved. The notice
shall be on a form

10prepared by the Illinois Department and shall state the 
11following:


12  (1) The name of the hospital provider.


13  (2) The address of the hospital provider's principal 
14 place
of business from which the provider engages in the 
15 occupation of hospital
provider in this State, and the name 
16 and address of each hospital
operated, conducted, or 
17 maintained by the provider in this State.


18  (3) The occupied bed days, occupied bed days less 
19 Medicare days, adjusted gross hospital revenue, or 
20 outpatient gross revenue of the
hospital
provider 
21 (whichever is applicable), the amount of
assessment 
22 imposed under Section 5A-2 for the State fiscal year
for 
23 which the notice is sent, and the amount of
each

24 installment to be paid during the State fiscal year.


25  (4) (Blank).


26  (5) Other reasonable information as determined by the 
 
 
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1 Illinois
Department.


2 (b) If a hospital provider conducts, operates, or
maintains 
3more than one hospital licensed by the Illinois
Department of 
4Public Health, the provider shall pay the
assessment for each 
5hospital separately.


6 (c) Notwithstanding any other provision in this Article, in

7the case of a person who ceases to conduct, operate, or 
8maintain a
hospital in respect of which the person is subject 
9to assessment
under this Article as a hospital provider, the 
10assessment for the State
fiscal year in which the cessation 
11occurs shall be adjusted by
multiplying the assessment computed 
12under Section 5A-2 by a
fraction, the numerator of which is the 
13number of days in the
year during which the provider conducts, 
14operates, or maintains
the hospital and the denominator of 
15which is 365. Immediately
upon ceasing to conduct, operate, or 
16maintain a hospital, the person
shall pay the assessment
for 
17the year as so adjusted (to the extent not previously paid).


18 (d) Notwithstanding any other provision in this Article, a

19provider who commences conducting, operating, or maintaining a

20hospital, upon notice by the Illinois Department,
shall pay the 
21assessment computed under Section 5A-2 and
subsection (e) in 
22installments on the due dates stated in the
notice and on the 
23regular installment due dates for the State
fiscal year 
24occurring after the due dates of the initial
notice.


25 (e)
Notwithstanding any other provision in this Article, 
26for State fiscal years 2009 through 2014 2015, in the case of a 
 
 
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1hospital provider that did not conduct, operate, or maintain a 
2hospital in 2005, the assessment for that State fiscal year 
3shall be computed on the basis of hypothetical occupied bed 
4days for the full calendar year as determined by the Illinois 
5Department. Notwithstanding any other provision in this 
6Article, for the portion of State fiscal year 2012 beginning 
7June 10, 2012 through June 30, 2012, and for State fiscal years 
82013 through 2014, and for July 1, 2014 through December 31, 
92014, in the case of a hospital provider that did not conduct, 
10operate, or maintain a hospital in 2009, the assessment under 
11subsection (b-5) of Section 5A-2 for that State fiscal year 
12shall be computed on the basis of hypothetical gross outpatient 
13revenue for the full calendar year as determined by the 
14Illinois Department. 

15 (f) Every hospital provider subject to assessment under 
16this Article shall keep sufficient records to permit the 
17determination of adjusted gross hospital revenue for the 
18hospital's fiscal year. All such records shall be kept in the 
19English language and shall, at all times during regular 
20business hours of the day, be subject to inspection by the 
21Illinois Department or its duly authorized agents and 
22employees.


23 (g) The Illinois Department may, by rule, provide a 
24hospital provider a reasonable opportunity to request a 
25clarification or correction of any clerical or computational 
26errors contained in the calculation of its assessment, but such 
 
 
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1corrections shall not extend to updating the cost report 
2information used to calculate the assessment.


3 (h) (Blank).


4(Source: P.A. 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; 
597-689, eff. 6-14-12; revised 10-17-12.)


6 (305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)

7 Sec. 5A-8. Hospital Provider Fund.

8 (a) There is created in the State Treasury the Hospital 
9Provider Fund.
Interest earned by the Fund shall be credited to 
10the Fund. The
Fund shall not be used to replace any moneys 
11appropriated to the
Medicaid program by the General Assembly.


12 (b) The Fund is created for the purpose of receiving moneys

13in accordance with Section 5A-6 and disbursing moneys only for 
14the following
purposes, notwithstanding any other provision of 
15law:


16  (1) For making payments to hospitals as required under 
17 this Code, under the Children's Health Insurance Program 
18 Act, under the Covering ALL KIDS Health Insurance Act, and 
19 under the Long Term Acute Care Hospital Quality Improvement 
20 Transfer Program Act.


21  (2) For the reimbursement of moneys collected by the

22 Illinois Department from hospitals or hospital providers 
23 through error or
mistake in performing the
activities 
24 authorized under this Code.


25  (3) For payment of administrative expenses incurred by 
 
 
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1 the
Illinois Department or its agent in performing 
2 activities
under this Code, under the Children's Health 
3 Insurance Program Act, under the Covering ALL KIDS Health 
4 Insurance Act, and under the Long Term Acute Care Hospital 
5 Quality Improvement Transfer Program Act.


6  (4) For payments of any amounts which are reimbursable 
7 to
the federal government for payments from this Fund which 
8 are
required to be paid by State warrant.


9  (5) For making transfers, as those transfers are 
10 authorized
in the proceedings authorizing debt under the 
11 Short Term Borrowing Act,
but transfers made under this 
12 paragraph (5) shall not exceed the
principal amount of debt 
13 issued in anticipation of the receipt by
the State of 
14 moneys to be deposited into the Fund.


15  (6) For making transfers to any other fund in the State 
16 treasury, but
transfers made under this paragraph (6) shall 
17 not exceed the amount transferred
previously from that 
18 other fund into the Hospital Provider Fund plus any 
19 interest that would have been earned by that fund on the 
20 monies that had been transferred.


21  (6.5) For making transfers to the Healthcare Provider 
22 Relief Fund, except that transfers made under this 
23 paragraph (6.5) shall not exceed $60,000,000 in the 
24 aggregate. 
25  (7) For making transfers not exceeding the following 
26 amounts, in State fiscal years 2013 and 2014 in each State 
 
 
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1 fiscal year during which an assessment is imposed pursuant 
2 to Section 5A-2, to the following designated funds:
3   Health and Human Services Medicaid Trust
4    Fund..............................$20,000,000
5   Long-Term Care Provider Fund..........$30,000,000
6   General Revenue Fund.................$80,000,000.
7 Transfers under this paragraph shall be made within 7 days 
8 after the payments have been received pursuant to the 
9 schedule of payments provided in subsection (a) of Section 
10 5A-4.
11  (7.1) For making transfers not exceeding the following 
12 amounts, in State fiscal year 2015, to the following 
13 designated funds:
14   Health and Human Services Medicaid Trust
15     Fund..............................$10,000,000
16   Long-Term Care Provider Fund..........$15,000,000
17   General Revenue Fund.................$40,000,000.
18 Transfers under this paragraph shall be made within 7 days 
19 after the payments have been received pursuant to the 
20 schedule of payments provided in subsection (a) of Section 
21 5A-4.


22  (7.5) (Blank).
23  (7.8) (Blank).
24  (7.9) (Blank).
25  (7.10) For State fiscal years 2013 and 2014, for making 
26 transfers of the moneys resulting from the assessment under 
 
 
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1 subsection (b-5) of Section 5A-2 and received from hospital 
2 providers under Section 5A-4 and transferred into the 
3 Hospital Provider Fund under Section 5A-6 to the designated 
4 funds not exceeding the following amounts in that State 
5 fiscal year:
6   Health Care Provider Relief Fund......$50,000,000
7  Transfers under this paragraph shall be made within 7 
8 days after the payments have been received pursuant to the 
9 schedule of payments provided in subsection (a) of Section 
10 5A-4. 
11  (7.11) For State fiscal year 2015, for making transfers 
12 of the moneys resulting from the assessment under 
13 subsection (b-5) of Section 5A-2 and received from hospital 
14 providers under Section 5A-4 and transferred into the 
15 Hospital Provider Fund under Section 5A-6 to the designated 
16 funds not exceeding the following amounts in that State 
17 fiscal year: 
18   Health Care Provider Relief Fund.....$25,000,000 
19  Transfers under this paragraph shall be made within 7 
20 days after the payments have been received pursuant to the 
21 schedule of payments provided in subsection (a) of Section 
22 5A-4. 
23  (7.12) For State fiscal year 2013, for increasing by 
24 21/365ths the transfer of the moneys resulting from the 
25 assessment under subsection (b-5) of Section 5A-2 and 
26 received from hospital providers under Section 5A-4 for the 
 
 
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1 portion of State fiscal year 2012 beginning June 10, 2012 
2 through June 30, 2012 and transferred into the Hospital 
3 Provider Fund under Section 5A-6 to the designated funds 
4 not exceeding the following amounts in that State fiscal 
5 year: 
6   Health Care Provider Relief Fund.......$2,870,000 
7  (8) For making refunds to hospital providers pursuant 
8 to Section 5A-10.


9 Disbursements from the Fund, other than transfers 
10authorized under
paragraphs (5) and (6) of this subsection, 
11shall be by
warrants drawn by the State Comptroller upon 
12receipt of vouchers
duly executed and certified by the Illinois 
13Department.


14 (c) The Fund shall consist of the following:


15  (1) All moneys collected or received by the Illinois

16 Department from the hospital provider assessment imposed 
17 by this
Article.


18  (2) All federal matching funds received by the Illinois

19 Department as a result of expenditures made by the Illinois

20 Department that are attributable to moneys deposited in the 
21 Fund.


22  (3) Any interest or penalty levied in conjunction with 
23 the
administration of this Article.


24  (4) Moneys transferred from another fund in the State 
25 treasury.


26  (5) All other moneys received for the Fund from any 
 
 
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1 other
source, including interest earned thereon.


2 (d) (Blank).


3(Source: P.A. 96-3, eff. 2-27-09; 96-45, eff. 7-15-09; 96-821, 
4eff. 11-20-09; 96-1530, eff. 2-16-11; 97-688, eff. 6-14-12; 
597-689, eff. 6-14-12; revised 10-17-12.)


6 (305 ILCS 5/5A-12.4)
7 (Section scheduled to be repealed on January 1, 2015)
8 Sec. 5A-12.4. Hospital access improvement payments on or 
9after June 10, 2012 July 1, 2012.
10 (a) Hospital access improvement payments. To preserve and 
11improve access to hospital services, for hospital and physician 
12services rendered on or after June 10, 2012 July 1, 2012, the 
13Illinois Department shall, except for hospitals described in 
14subsection (b) of Section 5A-3, make payments to hospitals as 
15set forth in this Section. These payments shall be paid in 12 
16equal installments on or before the 7th State business day of 
17each month, except that no payment shall be due within 100 days 
18after the later of the date of notification of federal approval 
19of the payment methodologies required under this Section or any 
20waiver required under 42 CFR 433.68, at which time the sum of 
21amounts required under this Section prior to the date of 
22notification is due and payable. Payments under this Section 
23are not due and payable, however, until (i) the methodologies 
24described in this Section are approved by the federal 
25government in an appropriate State Plan amendment and (ii) the 
 
 
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1assessment imposed under subsection (b-5) of Section 5A-2 of 
2this Article is determined to be a permissible tax under Title 
3XIX of the Social Security Act. The Illinois Department shall 
4take all actions necessary to implement the payments under this 
5Section effective June 10, 2012 July 1, 2012, including but not 
6limited to providing public notice pursuant to federal 
7requirements, the filing of a State Plan amendment, and the 
8adoption of administrative rules. For State fiscal year 2013, 
9payments under this Section shall be increased by 21/365ths of 
10the moneys resulting from the assessment under subsection (b-5) 
11of Section 5A-2 and received from hospital providers under 
12Section 5A-4 for the portion of State fiscal year 2012 
13beginning June 10, 2012 through June 30, 2012. 
14 (a-5) Accelerated schedule. The Illinois Department may, 
15when practicable, accelerate the schedule upon which payments 
16authorized under this Section are made.
17 (b) Magnet and perinatal hospital adjustment. In addition 
18to rates paid for inpatient hospital services, the Department 
19shall pay to each Illinois general acute care hospital that, as 
20of August 25, 2011, was recognized as a Magnet hospital by the 
21American Nurses Credentialing Center and that, as of September 
2214, 2011, was designated as a level III perinatal center 
23amounts as follows:
24  (1) For hospitals with a case mix index equal to or 
25 greater than the 80th percentile of case mix indices for 
26 all Illinois hospitals, $470 for each Medicaid general 
 
 
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1 acute care inpatient day of care provided by the hospital 
2 during State fiscal year 2009.
3  (2) For all other hospitals, $170 for each Medicaid 
4 general acute care inpatient day of care provided by the 
5 hospital during State fiscal year 2009.
6 (c) Trauma level II adjustment. In addition to rates paid 
7for inpatient hospital services, the Department shall pay to 
8each Illinois general acute care hospital that, as of July 1, 
92011, was designated as a level II trauma center amounts as 
10follows:
11  (1) For hospitals with a case mix index equal to or 
12 greater than the 50th percentile of case mix indices for 
13 all Illinois hospitals, $470 for each Medicaid general 
14 acute care inpatient day of care provided by the hospital 
15 during State fiscal year 2009.
16  (2) For all other hospitals, $170 for each Medicaid 
17 general acute care inpatient day of care provided by the 
18 hospital during State fiscal year 2009.
19  (3) For the purposes of this adjustment, hospitals 
20 located in the same city that alternate their trauma center 
21 designation as defined in 89 Ill. Adm. Code 148.295(a)(2) 
22 shall have the adjustment provided under this Section 
23 divided between the 2 hospitals.
24 (d) Dual-eligible adjustment. In addition to rates paid for 
25inpatient services, the Department shall pay each Illinois 
26general acute care hospital that had a ratio of crossover days 
 
 
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1to total inpatient days for programs under Title XIX of the 
2Social Security Act administered by the Department (utilizing 
3information from 2009 paid claims) greater than 50%, and a case 
4mix index equal to or greater than the 75th percentile of case 
5mix indices for all Illinois hospitals, a rate of $400 for each 
6Medicaid inpatient day during State fiscal year 2009 including 
7crossover days.
8 (e) Medicaid volume adjustment. In addition to rates paid 
9for inpatient hospital services, the Department shall pay to 
10each Illinois general acute care hospital that provided more 
11than 10,000 Medicaid inpatient days of care in State fiscal 
12year 2009, has a Medicaid inpatient utilization rate of at 
13least 29.05% as calculated by the Department for the Rate Year 
142011 Disproportionate Share determination, and is not eligible 
15for Medicaid Percentage Adjustment payments in rate year 2011 
16an amount equal to $135 for each Medicaid inpatient day of care 
17provided during State fiscal year 2009.
18 (f) Outpatient service adjustment. In addition to the rates 
19paid for outpatient hospital services, the Department shall pay 
20each Illinois hospital an amount at least equal to $100 
21multiplied by the hospital's outpatient ambulatory procedure 
22listing services (excluding categories 3B and 3C) and by the 
23hospital's end stage renal disease treatment services provided 
24for State fiscal year 2009.
25 (g) Ambulatory service adjustment.
26  (1) In addition to the rates paid for outpatient 
 
 
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1 hospital services provided in the emergency department, 
2 the Department shall pay each Illinois hospital an amount 
3 equal to $105 multiplied by the hospital's outpatient 
4 ambulatory procedure listing services for categories 3A, 
5 3B, and 3C for State fiscal year 2009.
6  (2) In addition to the rates paid for outpatient 
7 hospital services, the Department shall pay each Illinois 
8 freestanding psychiatric hospital an amount equal to $200 
9 multiplied by the hospital's ambulatory procedure listing 
10 services for category 5A for State fiscal year 2009.
11 (h) Specialty hospital adjustment. In addition to the rates 
12paid for outpatient hospital services, the Department shall pay 
13each Illinois long term acute care hospital and each Illinois 
14hospital devoted exclusively to the treatment of cancer, an 
15amount equal to $700 multiplied by the hospital's outpatient 
16ambulatory procedure listing services and by the hospital's end 
17stage renal disease treatment services (including services 
18provided to individuals eligible for both Medicaid and 
19Medicare) provided for State fiscal year 2009.
20 (h-1) ER Safety Net Payments. In addition to rates paid for 
21outpatient services, the Department shall pay to each Illinois 
22general acute care hospital with an emergency room ratio equal 
23to or greater than 55%, that is not eligible for Medicaid 
24percentage adjustments payments in rate year 2011, with a case 
25mix index equal to or greater than the 20th percentile, and 
26that is not designated as a trauma center by the Illinois 
 
 
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1Department of Public Health on July 1, 2011, as follows:
2  (1) Each hospital with an emergency room ratio equal to 
3 or greater than 74% shall receive a rate of $225 for each 
4 outpatient ambulatory procedure listing and end-stage 
5 renal disease treatment service provided for State fiscal 
6 year 2009.
7  (2) For all other hospitals, $65 shall be paid for each 
8 outpatient ambulatory procedure listing and end-stage 
9 renal disease treatment service provided for State fiscal 
10 year 2009. 
11 (i) Physician supplemental adjustment. In addition to the 
12rates paid for physician services, the Department shall make an 
13adjustment payment for services provided by physicians as 
14follows:
15  (1) Physician services eligible for the adjustment 
16 payment are those provided by physicians employed by or who 
17 have a contract to provide services to patients of the 
18 following hospitals: (i) Illinois general acute care 
19 hospitals that provided at least 17,000 Medicaid inpatient 
20 days of care in State fiscal year 2009 and are eligible for 
21 Medicaid Percentage Adjustment Payments in rate year 2011; 
22 and (ii) Illinois freestanding children's hospitals, as 
23 defined in 89 Ill. Adm. Code 149.50(c)(3)(A).
24  (2) The amount of the adjustment for each eligible 
25 hospital under this subsection (i) shall be determined by 
26 rule by the Department to spend a total pool of at least 
 
 
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1 $6,960,000 annually. This pool shall be allocated among the 
2 eligible hospitals based on the difference between the 
3 upper payment limit for what could have been paid under 
4 Medicaid for physician services provided during State 
5 fiscal year 2009 by physicians employed by or who had a 
6 contract with the hospital and the amount that was paid 
7 under Medicaid for such services, provided however, that in 
8 no event shall physicians at any individual hospital 
9 collectively receive an annual, aggregate adjustment in 
10 excess of $435,000, except that any amount that is not 
11 distributed to a hospital because of the upper payment 
12 limit shall be reallocated among the remaining eligible 
13 hospitals that are below the upper payment limitation, on a 
14 proportionate basis. 
15 (i-5) For any children's hospital which did not charge for 
16its services during the base period, the Department shall use 
17data supplied by the hospital to determine payments using 
18similar methodologies for freestanding children's hospitals 
19under this Section or Section 5A-12.2 12.2. 
20 (j) For purposes of this Section, a hospital that is 
21enrolled to provide Medicaid services during State fiscal year 
222009 shall have its utilization and associated reimbursements 
23annualized prior to the payment calculations being performed 
24under this Section.
25 (k) For purposes of this Section, the terms "Medicaid 
26days", "ambulatory procedure listing services", and 
 
 
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1"ambulatory procedure listing payments" do not include any 
2days, charges, or services for which Medicare or a managed care 
3organization reimbursed on a capitated basis was liable for 
4payment, except where explicitly stated otherwise in this 
5Section.
6 (l) Definitions. Unless the context requires otherwise or 
7unless provided otherwise in this Section, the terms used in 
8this Section for qualifying criteria and payment calculations 
9shall have the same meanings as those terms have been given in 
10the Illinois Department's administrative rules as in effect on 
11October 1, 2011. Other terms shall be defined by the Illinois 
12Department by rule.
13 As used in this Section, unless the context requires 
14otherwise:
15 "Case mix index" means, for a given hospital, the sum of

16the per admission (DRG) relative weighting factors in effect on 
17January 1, 2005, for all general acute care admissions for 
18State fiscal year 2009, excluding Medicare crossover 
19admissions and transplant admissions reimbursed under 89 Ill. 
20Adm. Code 148.82, divided by the total number of general acute 
21care admissions for State fiscal year 2009, excluding Medicare 
22crossover admissions and transplant admissions reimbursed 
23under 89 Ill. Adm. Code 148.82.
24 "Emergency room ratio" means, for a given hospital, a 
25fraction, the denominator of which is the number of the 
26hospital's outpatient ambulatory procedure listing and 
 
 
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1end-stage renal disease treatment services provided for State 
2fiscal year 2009 and the numerator of which is the hospital's 
3outpatient ambulatory procedure listing services for 
4categories 3A, 3B, and 3C for State fiscal year 2009. 
5 "Medicaid inpatient day" means, for a given hospital, the

6sum of days of inpatient hospital days provided to recipients 
7of medical assistance under Title XIX of the federal Social 
8Security Act, excluding days for individuals eligible for 
9Medicare under Title XVIII of that Act (Medicaid/Medicare 
10crossover days), as tabulated from the Department's paid claims 
11data for admissions occurring during State fiscal year 2009 
12that was adjudicated by the Department through June 30, 2010.
13 "Outpatient ambulatory procedure listing services" means, 
14for a given hospital, ambulatory procedure listing services, as 
15described in 89 Ill. Adm. Code 148.140(b), provided to 
16recipients of medical assistance under Title XIX of the federal 
17Social Security Act, excluding services for individuals 
18eligible for Medicare under Title XVIII of the Act 
19(Medicaid/Medicare crossover days), as tabulated from the 
20Department's paid claims data for services occurring in State 
21fiscal year 2009 that were adjudicated by the Department 
22through September 2, 2010.
23 "Outpatient end-stage renal disease treatment services" 
24means, for a given hospital, the services, as described in 89 
25Ill. Adm. Code 148.140(c), provided to recipients of medical 
26assistance under Title XIX of the federal Social Security Act, 
 
 
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1excluding payments for individuals eligible for Medicare under 
2Title XVIII of the Act (Medicaid/Medicare crossover days), as 
3tabulated from the Department's paid claims data for services 
4occurring in State fiscal year 2009 that were adjudicated by 
5the Department through September 2, 2010.
6 (m) The Department may adjust payments made under this 
7Section 5A-12.4 to comply with federal law or regulations 
8regarding hospital-specific payment limitations on 
9government-owned or government-operated hospitals.
10 (n) Notwithstanding any of the other provisions of this 
11Section, the Department is authorized to adopt rules that 
12change the hospital access improvement payments specified in 
13this Section, but only to the extent necessary to conform to 
14any federally approved amendment to the Title XIX State plan. 
15Any such rules shall be adopted by the Department as authorized 
16by Section 5-50 of the Illinois Administrative Procedure Act. 
17Notwithstanding any other provision of law, any changes 
18implemented as a result of this subsection (n) shall be given 
19retroactive effect so that they shall be deemed to have taken 
20effect as of the effective date of this Section. 
21 (o) The Department of Healthcare and Family Services must 
22submit a State Medicaid Plan Amendment to the Centers of 
23Medicare and Medicaid Services to implement the payments under 
24this Section within 30 days of June 14, 2012 (the effective 
25date of Public Act 97-688) this Act. 

26(Source: P.A. 97-688, eff. 6-14-12; revised 8-3-12.)".