Illinois 2023-2024 Regular Session

Illinois House Bill HB3220 Compare Versions

Only one version of the bill is available at this time.

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1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3220 Introduced , by Rep. Kam Buckner SYNOPSIS AS INTRODUCED: 305 ILCS 5/5A-12.7 Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. Provides that in order to address the escalating infant mortality rates among minority communities in Illinois, the State shall, subject to appropriation, create a pool of funding of at least $55,000,000 (rather than $50,000,000) annually to be disbursed among safety-net hospitals that maintain perinatal designation from the Department of Public Health. Provides that $5,000,000 of this amount shall be disbursed to non-safety net hospitals that serve at least 44% Medicaid patients and handle a minimum of 1,000 births per year and are designated by the Department of Public Health as perinatal level III hospitals to maintain access to such services for Medicaid eligible mothers and babies. LRB103 29689 KTG 56093 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3220 Introduced , by Rep. Kam Buckner SYNOPSIS AS INTRODUCED: 305 ILCS 5/5A-12.7 305 ILCS 5/5A-12.7 Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. Provides that in order to address the escalating infant mortality rates among minority communities in Illinois, the State shall, subject to appropriation, create a pool of funding of at least $55,000,000 (rather than $50,000,000) annually to be disbursed among safety-net hospitals that maintain perinatal designation from the Department of Public Health. Provides that $5,000,000 of this amount shall be disbursed to non-safety net hospitals that serve at least 44% Medicaid patients and handle a minimum of 1,000 births per year and are designated by the Department of Public Health as perinatal level III hospitals to maintain access to such services for Medicaid eligible mothers and babies. LRB103 29689 KTG 56093 b LRB103 29689 KTG 56093 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3220 Introduced , by Rep. Kam Buckner SYNOPSIS AS INTRODUCED:
3	3	305 ILCS 5/5A-12.7 305 ILCS 5/5A-12.7
4	4	305 ILCS 5/5A-12.7
5	5	Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. Provides that in order to address the escalating infant mortality rates among minority communities in Illinois, the State shall, subject to appropriation, create a pool of funding of at least $55,000,000 (rather than $50,000,000) annually to be disbursed among safety-net hospitals that maintain perinatal designation from the Department of Public Health. Provides that $5,000,000 of this amount shall be disbursed to non-safety net hospitals that serve at least 44% Medicaid patients and handle a minimum of 1,000 births per year and are designated by the Department of Public Health as perinatal level III hospitals to maintain access to such services for Medicaid eligible mothers and babies.
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8	8	A BILL FOR
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11	11	1 AN ACT concerning public aid.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Public Aid Code is amended by
15	15	5 changing Section 5A-12.7 as follows:
16	16	6 (305 ILCS 5/5A-12.7)
17	17	7 (Section scheduled to be repealed on December 31, 2026)
18	18	8 Sec. 5A-12.7. Continuation of hospital access payments on
19	19	9 and after July 1, 2020.
20	20	10 (a) To preserve and improve access to hospital services,
21	21	11 for hospital services rendered on and after July 1, 2020, the
22	22	12 Department shall, except for hospitals described in subsection
23	23	13 (b) of Section 5A-3, make payments to hospitals or require
24	24	14 capitated managed care organizations to make payments as set
25	25	15 forth in this Section. Payments under this Section are not due
26	26	16 and payable, however, until: (i) the methodologies described
27	27	17 in this Section are approved by the federal government in an
28	28	18 appropriate State Plan amendment or directed payment preprint;
29	29	19 and (ii) the assessment imposed under this Article is
30	30	20 determined to be a permissible tax under Title XIX of the
31	31	21 Social Security Act. In determining the hospital access
32	32	22 payments authorized under subsection (g) of this Section, if a
33	33	23 hospital ceases to qualify for payments from the pool, the
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3220 Introduced , by Rep. Kam Buckner SYNOPSIS AS INTRODUCED:
38	38	305 ILCS 5/5A-12.7 305 ILCS 5/5A-12.7
39	39	305 ILCS 5/5A-12.7
40	40	Amends the Hospital Provider Funding Article of the Illinois Public Aid Code. Provides that in order to address the escalating infant mortality rates among minority communities in Illinois, the State shall, subject to appropriation, create a pool of funding of at least $55,000,000 (rather than $50,000,000) annually to be disbursed among safety-net hospitals that maintain perinatal designation from the Department of Public Health. Provides that $5,000,000 of this amount shall be disbursed to non-safety net hospitals that serve at least 44% Medicaid patients and handle a minimum of 1,000 births per year and are designated by the Department of Public Health as perinatal level III hospitals to maintain access to such services for Medicaid eligible mothers and babies.
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43	43	A BILL FOR
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68	68	1 payments for all hospitals continuing to qualify for payments
69	69	2 from such pool shall be uniformly adjusted to fully expend the
70	70	3 aggregate net amount of the pool, with such adjustment being
71	71	4 effective on the first day of the second month following the
72	72	5 date the hospital ceases to receive payments from such pool.
73	73	6 (b) Amounts moved into claims-based rates and distributed
74	74	7 in accordance with Section 14-12 shall remain in those
75	75	8 claims-based rates.
76	76	9 (c) Graduate medical education.
77	77	10 (1) The calculation of graduate medical education
78	78	11 payments shall be based on the hospital's Medicare cost
79	79	12 report ending in Calendar Year 2018, as reported in the
80	80	13 Healthcare Cost Report Information System file, release
81	81	14 date September 30, 2019. An Illinois hospital reporting
82	82	15 intern and resident cost on its Medicare cost report shall
83	83	16 be eligible for graduate medical education payments.
84	84	17 (2) Each hospital's annualized Medicaid Intern
85	85	18 Resident Cost is calculated using annualized intern and
86	86	19 resident total costs obtained from Worksheet B Part I,
87	87	20 Columns 21 and 22 the sum of Lines 30-43, 50-76, 90-93,
88	88	21 96-98, and 105-112 multiplied by the percentage that the
89	89	22 hospital's Medicaid days (Worksheet S3 Part I, Column 7,
90	90	23 Lines 2, 3, 4, 14, 16-18, and 32) comprise of the
91	91	24 hospital's total days (Worksheet S3 Part I, Column 8,
92	92	25 Lines 14, 16-18, and 32).
93	93	26 (3) An annualized Medicaid indirect medical education
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104	104	1 (IME) payment is calculated for each hospital using its
105	105	2 IME payments (Worksheet E Part A, Line 29, Column 1)
106	106	3 multiplied by the percentage that its Medicaid days
107	107	4 (Worksheet S3 Part I, Column 7, Lines 2, 3, 4, 14, 16-18,
108	108	5 and 32) comprise of its Medicare days (Worksheet S3 Part
109	109	6 I, Column 6, Lines 2, 3, 4, 14, and 16-18).
110	110	7 (4) For each hospital, its annualized Medicaid Intern
111	111	8 Resident Cost and its annualized Medicaid IME payment are
112	112	9 summed, and, except as capped at 120% of the average cost
113	113	10 per intern and resident for all qualifying hospitals as
114	114	11 calculated under this paragraph, is multiplied by the
115	115	12 applicable reimbursement factor as described in this
116	116	13 paragraph, to determine the hospital's final graduate
117	117	14 medical education payment. Each hospital's average cost
118	118	15 per intern and resident shall be calculated by summing its
119	119	16 total annualized Medicaid Intern Resident Cost plus its
120	120	17 annualized Medicaid IME payment and dividing that amount
121	121	18 by the hospital's total Full Time Equivalent Residents and
122	122	19 Interns. If the hospital's average per intern and resident
123	123	20 cost is greater than 120% of the same calculation for all
124	124	21 qualifying hospitals, the hospital's per intern and
125	125	22 resident cost shall be capped at 120% of the average cost
126	126	23 for all qualifying hospitals.
127	127	24 (A) For the period of July 1, 2020 through
128	128	25 December 31, 2022, the applicable reimbursement factor
129	129	26 shall be 22.6%.
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140	140	1 (B) For the period of January 1, 2023 through
141	141	2 December 31, 2026, the applicable reimbursement factor
142	142	3 shall be 35% for all qualified safety-net hospitals,
143	143	4 as defined in Section 5-5e.1 of this Code, and all
144	144	5 hospitals with 100 or more Full Time Equivalent
145	145	6 Residents and Interns, as reported on the hospital's
146	146	7 Medicare cost report ending in Calendar Year 2018, and
147	147	8 for all other qualified hospitals the applicable
148	148	9 reimbursement factor shall be 30%.
149	149	10 (d) Fee-for-service supplemental payments. For the period
150	150	11 of July 1, 2020 through December 31, 2022, each Illinois
151	151	12 hospital shall receive an annual payment equal to the amounts
152	152	13 below, to be paid in 12 equal installments on or before the
153	153	14 seventh State business day of each month, except that no
154	154	15 payment shall be due within 30 days after the later of the date
155	155	16 of notification of federal approval of the payment
156	156	17 methodologies required under this Section or any waiver
157	157	18 required under 42 CFR 433.68, at which time the sum of amounts
158	158	19 required under this Section prior to the date of notification
159	159	20 is due and payable.
160	160	21 (1) For critical access hospitals, $385 per covered
161	161	22 inpatient day contained in paid fee-for-service claims and
162	162	23 $530 per paid fee-for-service outpatient claim for dates
163	163	24 of service in Calendar Year 2019 in the Department's
164	164	25 Enterprise Data Warehouse as of May 11, 2020.
165	165	26 (2) For safety-net hospitals, $960 per covered
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176	176	1 inpatient day contained in paid fee-for-service claims and
177	177	2 $625 per paid fee-for-service outpatient claim for dates
178	178	3 of service in Calendar Year 2019 in the Department's
179	179	4 Enterprise Data Warehouse as of May 11, 2020.
180	180	5 (3) For long term acute care hospitals, $295 per
181	181	6 covered inpatient day contained in paid fee-for-service
182	182	7 claims for dates of service in Calendar Year 2019 in the
183	183	8 Department's Enterprise Data Warehouse as of May 11, 2020.
184	184	9 (4) For freestanding psychiatric hospitals, $125 per
185	185	10 covered inpatient day contained in paid fee-for-service
186	186	11 claims and $130 per paid fee-for-service outpatient claim
187	187	12 for dates of service in Calendar Year 2019 in the
188	188	13 Department's Enterprise Data Warehouse as of May 11, 2020.
189	189	14 (5) For freestanding rehabilitation hospitals, $355
190	190	15 per covered inpatient day contained in paid
191	191	16 fee-for-service claims for dates of service in Calendar
192	192	17 Year 2019 in the Department's Enterprise Data Warehouse as
193	193	18 of May 11, 2020.
194	194	19 (6) For all general acute care hospitals and high
195	195	20 Medicaid hospitals as defined in subsection (f), $350 per
196	196	21 covered inpatient day for dates of service in Calendar
197	197	22 Year 2019 contained in paid fee-for-service claims and
198	198	23 $620 per paid fee-for-service outpatient claim in the
199	199	24 Department's Enterprise Data Warehouse as of May 11, 2020.
200	200	25 (7) Alzheimer's treatment access payment. Each
201	201	26 Illinois academic medical center or teaching hospital, as
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212	212	1 defined in Section 5-5e.2 of this Code, that is identified
213	213	2 as the primary hospital affiliate of one of the Regional
214	214	3 Alzheimer's Disease Assistance Centers, as designated by
215	215	4 the Alzheimer's Disease Assistance Act and identified in
216	216	5 the Department of Public Health's Alzheimer's Disease
217	217	6 State Plan dated December 2016, shall be paid an
218	218	7 Alzheimer's treatment access payment equal to the product
219	219	8 of the qualifying hospital's State Fiscal Year 2018 total
220	220	9 inpatient fee-for-service days multiplied by the
221	221	10 applicable Alzheimer's treatment rate of $226.30 for
222	222	11 hospitals located in Cook County and $116.21 for hospitals
223	223	12 located outside Cook County.
224	224	13 (d-2) Fee-for-service supplemental payments. Beginning
225	225	14 January 1, 2023, each Illinois hospital shall receive an
226	226	15 annual payment equal to the amounts listed below, to be paid in
227	227	16 12 equal installments on or before the seventh State business
228	228	17 day of each month, except that no payment shall be due within
229	229	18 30 days after the later of the date of notification of federal
230	230	19 approval of the payment methodologies required under this
231	231	20 Section or any waiver required under 42 CFR 433.68, at which
232	232	21 time the sum of amounts required under this Section prior to
233	233	22 the date of notification is due and payable. The Department
234	234	23 may adjust the rates in paragraphs (1) through (7) to comply
235	235	24 with the federal upper payment limits, with such adjustments
236	236	25 being determined so that the total estimated spending by
237	237	26 hospital class, under such adjusted rates, remains
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248	248	1 substantially similar to the total estimated spending under
249	249	2 the original rates set forth in this subsection.
250	250	3 (1) For critical access hospitals, as defined in
251	251	4 subsection (f), $750 per covered inpatient day contained
252	252	5 in paid fee-for-service claims and $750 per paid
253	253	6 fee-for-service outpatient claim for dates of service in
254	254	7 Calendar Year 2019 in the Department's Enterprise Data
255	255	8 Warehouse as of August 6, 2021.
256	256	9 (2) For safety-net hospitals, as described in
257	257	10 subsection (f), $1,350 per inpatient day contained in paid
258	258	11 fee-for-service claims and $1,350 per paid fee-for-service
259	259	12 outpatient claim for dates of service in Calendar Year
260	260	13 2019 in the Department's Enterprise Data Warehouse as of
261	261	14 August 6, 2021.
262	262	15 (3) For long term acute care hospitals, $550 per
263	263	16 covered inpatient day contained in paid fee-for-service
264	264	17 claims for dates of service in Calendar Year 2019 in the
265	265	18 Department's Enterprise Data Warehouse as of August 6,
266	266	19 2021.
267	267	20 (4) For freestanding psychiatric hospitals, $200 per
268	268	21 covered inpatient day contained in paid fee-for-service
269	269	22 claims and $200 per paid fee-for-service outpatient claim
270	270	23 for dates of service in Calendar Year 2019 in the
271	271	24 Department's Enterprise Data Warehouse as of August 6,
272	272	25 2021.
273	273	26 (5) For freestanding rehabilitation hospitals, $550
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284	284	1 per covered inpatient day contained in paid
285	285	2 fee-for-service claims and $125 per paid fee-for-service
286	286	3 outpatient claim for dates of service in Calendar Year
287	287	4 2019 in the Department's Enterprise Data Warehouse as of
288	288	5 August 6, 2021.
289	289	6 (6) For all general acute care hospitals and high
290	290	7 Medicaid hospitals as defined in subsection (f), $500 per
291	291	8 covered inpatient day for dates of service in Calendar
292	292	9 Year 2019 contained in paid fee-for-service claims and
293	293	10 $500 per paid fee-for-service outpatient claim in the
294	294	11 Department's Enterprise Data Warehouse as of August 6,
295	295	12 2021.
296	296	13 (7) For public hospitals, as defined in subsection
297	297	14 (f), $275 per covered inpatient day contained in paid
298	298	15 fee-for-service claims and $275 per paid fee-for-service
299	299	16 outpatient claim for dates of service in Calendar Year
300	300	17 2019 in the Department's Enterprise Data Warehouse as of
301	301	18 August 6, 2021.
302	302	19 (8) Alzheimer's treatment access payment. Each
303	303	20 Illinois academic medical center or teaching hospital, as
304	304	21 defined in Section 5-5e.2 of this Code, that is identified
305	305	22 as the primary hospital affiliate of one of the Regional
306	306	23 Alzheimer's Disease Assistance Centers, as designated by
307	307	24 the Alzheimer's Disease Assistance Act and identified in
308	308	25 the Department of Public Health's Alzheimer's Disease
309	309	26 State Plan dated December 2016, shall be paid an
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320	320	1 Alzheimer's treatment access payment equal to the product
321	321	2 of the qualifying hospital's Calendar Year 2019 total
322	322	3 inpatient fee-for-service days, in the Department's
323	323	4 Enterprise Data Warehouse as of August 6, 2021, multiplied
324	324	5 by the applicable Alzheimer's treatment rate of $244.37
325	325	6 for hospitals located in Cook County and $312.03 for
326	326	7 hospitals located outside Cook County.
327	327	8 (e) The Department shall require managed care
328	328	9 organizations (MCOs) to make directed payments and
329	329	10 pass-through payments according to this Section. Each calendar
330	330	11 year, the Department shall require MCOs to pay the maximum
331	331	12 amount out of these funds as allowed as pass-through payments
332	332	13 under federal regulations. The Department shall require MCOs
333	333	14 to make such pass-through payments as specified in this
334	334	15 Section. The Department shall require the MCOs to pay the
335	335	16 remaining amounts as directed Payments as specified in this
336	336	17 Section. The Department shall issue payments to the
337	337	18 Comptroller by the seventh business day of each month for all
338	338	19 MCOs that are sufficient for MCOs to make the directed
339	339	20 payments and pass-through payments according to this Section.
340	340	21 The Department shall require the MCOs to make pass-through
341	341	22 payments and directed payments using electronic funds
342	342	23 transfers (EFT), if the hospital provides the information
343	343	24 necessary to process such EFTs, in accordance with directions
344	344	25 provided monthly by the Department, within 7 business days of
345	345	26 the date the funds are paid to the MCOs, as indicated by the
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356	356	1 "Paid Date" on the website of the Office of the Comptroller if
357	357	2 the funds are paid by EFT and the MCOs have received directed
358	358	3 payment instructions. If funds are not paid through the
359	359	4 Comptroller by EFT, payment must be made within 7 business
360	360	5 days of the date actually received by the MCO. The MCO will be
361	361	6 considered to have paid the pass-through payments when the
362	362	7 payment remittance number is generated or the date the MCO
363	363	8 sends the check to the hospital, if EFT information is not
364	364	9 supplied. If an MCO is late in paying a pass-through payment or
365	365	10 directed payment as required under this Section (including any
366	366	11 extensions granted by the Department), it shall pay a penalty,
367	367	12 unless waived by the Department for reasonable cause, to the
368	368	13 Department equal to 5% of the amount of the pass-through
369	369	14 payment or directed payment not paid on or before the due date
370	370	15 plus 5% of the portion thereof remaining unpaid on the last day
371	371	16 of each 30-day period thereafter. Payments to MCOs that would
372	372	17 be paid consistent with actuarial certification and enrollment
373	373	18 in the absence of the increased capitation payments under this
374	374	19 Section shall not be reduced as a consequence of payments made
375	375	20 under this subsection. The Department shall publish and
376	376	21 maintain on its website for a period of no less than 8 calendar
377	377	22 quarters, the quarterly calculation of directed payments and
378	378	23 pass-through payments owed to each hospital from each MCO. All
379	379	24 calculations and reports shall be posted no later than the
380	380	25 first day of the quarter for which the payments are to be
381	381	26 issued.
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392	392	1 (f)(1) For purposes of allocating the funds included in
393	393	2 capitation payments to MCOs, Illinois hospitals shall be
394	394	3 divided into the following classes as defined in
395	395	4 administrative rules:
396	396	5 (A) Beginning July 1, 2020 through December 31, 2022,
397	397	6 critical access hospitals. Beginning January 1, 2023,
398	398	7 "critical access hospital" means a hospital designated by
399	399	8 the Department of Public Health as a critical access
400	400	9 hospital, excluding any hospital meeting the definition of
401	401	10 a public hospital in subparagraph (F).
402	402	11 (B) Safety-net hospitals, except that stand-alone
403	403	12 children's hospitals that are not specialty children's
404	404	13 hospitals will not be included. For the calendar year
405	405	14 beginning January 1, 2023, and each calendar year
406	406	15 thereafter, assignment to the safety-net class shall be
407	407	16 based on the annual safety-net rate year beginning 15
408	408	17 months before the beginning of the first Payout Quarter of
409	409	18 the calendar year.
410	410	19 (C) Long term acute care hospitals.
411	411	20 (D) Freestanding psychiatric hospitals.
412	412	21 (E) Freestanding rehabilitation hospitals.
413	413	22 (F) Beginning January 1, 2023, "public hospital" means
414	414	23 a hospital that is owned or operated by an Illinois
415	415	24 Government body or municipality, excluding a hospital
416	416	25 provider that is a State agency, a State university, or a
417	417	26 county with a population of 3,000,000 or more.
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428	428	1 (G) High Medicaid hospitals.
429	429	2 (i) As used in this Section, "high Medicaid
430	430	3 hospital" means a general acute care hospital that:
431	431	4 (I) For the payout periods July 1, 2020
432	432	5 through December 31, 2022, is not a safety-net
433	433	6 hospital or critical access hospital and that has
434	434	7 a Medicaid Inpatient Utilization Rate above 30% or
435	435	8 a hospital that had over 35,000 inpatient Medicaid
436	436	9 days during the applicable period. For the period
437	437	10 July 1, 2020 through December 31, 2020, the
438	438	11 applicable period for the Medicaid Inpatient
439	439	12 Utilization Rate (MIUR) is the rate year 2020 MIUR
440	440	13 and for the number of inpatient days it is State
441	441	14 fiscal year 2018. Beginning in calendar year 2021,
442	442	15 the Department shall use the most recently
443	443	16 determined MIUR, as defined in subsection (h) of
444	444	17 Section 5-5.02, and for the inpatient day
445	445	18 threshold, the State fiscal year ending 18 months
446	446	19 prior to the beginning of the calendar year. For
447	447	20 purposes of calculating MIUR under this Section,
448	448	21 children's hospitals and affiliated general acute
449	449	22 care hospitals shall be considered a single
450	450	23 hospital.
451	451	24 (II) For the calendar year beginning January
452	452	25 1, 2023, and each calendar year thereafter, is not
453	453	26 a public hospital, safety-net hospital, or
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460	460
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462	462	HB3220- 13 -LRB103 29689 KTG 56093 b HB3220 - 13 - LRB103 29689 KTG 56093 b
463	463	HB3220 - 13 - LRB103 29689 KTG 56093 b
464	464	1 critical access hospital and that qualifies as a
465	465	2 regional high volume hospital or is a hospital
466	466	3 that has a Medicaid Inpatient Utilization Rate
467	467	4 (MIUR) above 30%. As used in this item, "regional
468	468	5 high volume hospital" means a hospital which ranks
469	469	6 in the top 2 quartiles based on total hospital
470	470	7 services volume, of all eligible general acute
471	471	8 care hospitals, when ranked in descending order
472	472	9 based on total hospital services volume, within
473	473	10 the same Medicaid managed care region, as
474	474	11 designated by the Department, as of January 1,
475	475	12 2022. As used in this item, "total hospital
476	476	13 services volume" means the total of all Medical
477	477	14 Assistance hospital inpatient admissions plus all
478	478	15 Medical Assistance hospital outpatient visits. For
479	479	16 purposes of determining regional high volume
480	480	17 hospital inpatient admissions and outpatient
481	481	18 visits, the Department shall use dates of service
482	482	19 provided during State Fiscal Year 2020 for the
483	483	20 Payout Quarter beginning January 1, 2023. The
484	484	21 Department shall use dates of service from the
485	485	22 State fiscal year ending 18 month before the
486	486	23 beginning of the first Payout Quarter of the
487	487	24 subsequent annual determination period.
488	488	25 (ii) For the calendar year beginning January 1,
489	489	26 2023, the Department shall use the Rate Year 2022
490	490
491	491
492	492
493	493
494	494
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496	496
497	497
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499	499	HB3220 - 14 - LRB103 29689 KTG 56093 b
500	500	1 Medicaid inpatient utilization rate (MIUR), as defined
501	501	2 in subsection (h) of Section 5-5.02. For each
502	502	3 subsequent annual determination, the Department shall
503	503	4 use the MIUR applicable to the rate year ending
504	504	5 September 30 of the year preceding the beginning of
505	505	6 the calendar year.
506	506	7 (H) General acute care hospitals. As used under this
507	507	8 Section, "general acute care hospitals" means all other
508	508	9 Illinois hospitals not identified in subparagraphs (A)
509	509	10 through (G).
510	510	11 (2) Hospitals' qualification for each class shall be
511	511	12 assessed prior to the beginning of each calendar year and the
512	512	13 new class designation shall be effective January 1 of the next
513	513	14 year. The Department shall publish by rule the process for
514	514	15 establishing class determination.
515	515	16 (g) Fixed pool directed payments. Beginning July 1, 2020,
516	516	17 the Department shall issue payments to MCOs which shall be
517	517	18 used to issue directed payments to qualified Illinois
518	518	19 safety-net hospitals and critical access hospitals on a
519	519	20 monthly basis in accordance with this subsection. Prior to the
520	520	21 beginning of each Payout Quarter beginning July 1, 2020, the
521	521	22 Department shall use encounter claims data from the
522	522	23 Determination Quarter, accepted by the Department's Medicaid
523	523	24 Management Information System for inpatient and outpatient
524	524	25 services rendered by safety-net hospitals and critical access
525	525	26 hospitals to determine a quarterly uniform per unit add-on for
526	526
527	527
528	528
529	529
530	530
531	531	HB3220 - 14 - LRB103 29689 KTG 56093 b
532	532
533	533
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535	535	HB3220 - 15 - LRB103 29689 KTG 56093 b
536	536	1 each hospital class.
537	537	2 (1) Inpatient per unit add-on. A quarterly uniform per
538	538	3 diem add-on shall be derived by dividing the quarterly
539	539	4 Inpatient Directed Payments Pool amount allocated to the
540	540	5 applicable hospital class by the total inpatient days
541	541	6 contained on all encounter claims received during the
542	542	7 Determination Quarter, for all hospitals in the class.
543	543	8 (A) Each hospital in the class shall have a
544	544	9 quarterly inpatient directed payment calculated that
545	545	10 is equal to the product of the number of inpatient days
546	546	11 attributable to the hospital used in the calculation
547	547	12 of the quarterly uniform class per diem add-on,
548	548	13 multiplied by the calculated applicable quarterly
549	549	14 uniform class per diem add-on of the hospital class.
550	550	15 (B) Each hospital shall be paid 1/3 of its
551	551	16 quarterly inpatient directed payment in each of the 3
552	552	17 months of the Payout Quarter, in accordance with
553	553	18 directions provided to each MCO by the Department.
554	554	19 (2) Outpatient per unit add-on. A quarterly uniform
555	555	20 per claim add-on shall be derived by dividing the
556	556	21 quarterly Outpatient Directed Payments Pool amount
557	557	22 allocated to the applicable hospital class by the total
558	558	23 outpatient encounter claims received during the
559	559	24 Determination Quarter, for all hospitals in the class.
560	560	25 (A) Each hospital in the class shall have a
561	561	26 quarterly outpatient directed payment calculated that
562	562
563	563
564	564
565	565
566	566
567	567	HB3220 - 15 - LRB103 29689 KTG 56093 b
568	568
569	569
570	570	HB3220- 16 -LRB103 29689 KTG 56093 b HB3220 - 16 - LRB103 29689 KTG 56093 b
571	571	HB3220 - 16 - LRB103 29689 KTG 56093 b
572	572	1 is equal to the product of the number of outpatient
573	573	2 encounter claims attributable to the hospital used in
574	574	3 the calculation of the quarterly uniform class per
575	575	4 claim add-on, multiplied by the calculated applicable
576	576	5 quarterly uniform class per claim add-on of the
577	577	6 hospital class.
578	578	7 (B) Each hospital shall be paid 1/3 of its
579	579	8 quarterly outpatient directed payment in each of the 3
580	580	9 months of the Payout Quarter, in accordance with
581	581	10 directions provided to each MCO by the Department.
582	582	11 (3) Each MCO shall pay each hospital the Monthly
583	583	12 Directed Payment as identified by the Department on its
584	584	13 quarterly determination report.
585	585	14 (4) Definitions. As used in this subsection:
586	586	15 (A) "Payout Quarter" means each 3 month calendar
587	587	16 quarter, beginning July 1, 2020.
588	588	17 (B) "Determination Quarter" means each 3 month
589	589	18 calendar quarter, which ends 3 months prior to the
590	590	19 first day of each Payout Quarter.
591	591	20 (5) For the period July 1, 2020 through December 2020,
592	592	21 the following amounts shall be allocated to the following
593	593	22 hospital class directed payment pools for the quarterly
594	594	23 development of a uniform per unit add-on:
595	595	24 (A) $2,894,500 for hospital inpatient services for
596	596	25 critical access hospitals.
597	597	26 (B) $4,294,374 for hospital outpatient services
598	598
599	599
600	600
601	601
602	602
603	603	HB3220 - 16 - LRB103 29689 KTG 56093 b
604	604
605	605
606	606	HB3220- 17 -LRB103 29689 KTG 56093 b HB3220 - 17 - LRB103 29689 KTG 56093 b
607	607	HB3220 - 17 - LRB103 29689 KTG 56093 b
608	608	1 for critical access hospitals.
609	609	2 (C) $29,109,330 for hospital inpatient services
610	610	3 for safety-net hospitals.
611	611	4 (D) $35,041,218 for hospital outpatient services
612	612	5 for safety-net hospitals.
613	613	6 (6) For the period January 1, 2023 through December
614	614	7 31, 2023, the Department shall establish the amounts that
615	615	8 shall be allocated to the hospital class directed payment
616	616	9 fixed pools identified in this paragraph for the quarterly
617	617	10 development of a uniform per unit add-on. The Department
618	618	11 shall establish such amounts so that the total amount of
619	619	12 payments to each hospital under this Section in calendar
620	620	13 year 2023 is projected to be substantially similar to the
621	621	14 total amount of such payments received by the hospital
622	622	15 under this Section in calendar year 2021, adjusted for
623	623	16 increased funding provided for fixed pool directed
624	624	17 payments under subsection (g) in calendar year 2022,
625	625	18 assuming that the volume and acuity of claims are held
626	626	19 constant. The Department shall publish the directed
627	627	20 payment fixed pool amounts to be established under this
628	628	21 paragraph on its website by November 15, 2022.
629	629	22 (A) Hospital inpatient services for critical
630	630	23 access hospitals.
631	631	24 (B) Hospital outpatient services for critical
632	632	25 access hospitals.
633	633	26 (C) Hospital inpatient services for public
634	634
635	635
636	636
637	637
638	638
639	639	HB3220 - 17 - LRB103 29689 KTG 56093 b
640	640
641	641
642	642	HB3220- 18 -LRB103 29689 KTG 56093 b HB3220 - 18 - LRB103 29689 KTG 56093 b
643	643	HB3220 - 18 - LRB103 29689 KTG 56093 b
644	644	1 hospitals.
645	645	2 (D) Hospital outpatient services for public
646	646	3 hospitals.
647	647	4 (E) Hospital inpatient services for safety-net
648	648	5 hospitals.
649	649	6 (F) Hospital outpatient services for safety-net
650	650	7 hospitals.
651	651	8 (7) Semi-annual rate maintenance review. The
652	652	9 Department shall ensure that hospitals assigned to the
653	653	10 fixed pools in paragraph (6) are paid no less than 95% of
654	654	11 the annual initial rate for each 6-month period of each
655	655	12 annual payout period. For each calendar year, the
656	656	13 Department shall calculate the annual initial rate per day
657	657	14 and per visit for each fixed pool hospital class listed in
658	658	15 paragraph (6), by dividing the total of all applicable
659	659	16 inpatient or outpatient directed payments issued in the
660	660	17 preceding calendar year to the hospitals in each fixed
661	661	18 pool class for the calendar year, plus any increase
662	662	19 resulting from the annual adjustments described in
663	663	20 subsection (i), by the actual applicable total service
664	664	21 units for the preceding calendar year which were the basis
665	665	22 of the total applicable inpatient or outpatient directed
666	666	23 payments issued to the hospitals in each fixed pool class
667	667	24 in the calendar year, except that for calendar year 2023,
668	668	25 the service units from calendar year 2021 shall be used.
669	669	26 (A) The Department shall calculate the effective
670	670
671	671
672	672
673	673
674	674
675	675	HB3220 - 18 - LRB103 29689 KTG 56093 b
676	676
677	677
678	678	HB3220- 19 -LRB103 29689 KTG 56093 b HB3220 - 19 - LRB103 29689 KTG 56093 b
679	679	HB3220 - 19 - LRB103 29689 KTG 56093 b
680	680	1 rate, per day and per visit, for the payout periods of
681	681	2 January to June and July to December of each year, for
682	682	3 each fixed pool listed in paragraph (6), by dividing
683	683	4 50% of the annual pool by the total applicable
684	684	5 reported service units for the 2 applicable
685	685	6 determination quarters.
686	686	7 (B) If the effective rate calculated in
687	687	8 subparagraph (A) is less than 95% of the annual
688	688	9 initial rate assigned to the class for each pool under
689	689	10 paragraph (6), the Department shall adjust the payment
690	690	11 for each hospital to a level equal to no less than 95%
691	691	12 of the annual initial rate, by issuing a retroactive
692	692	13 adjustment payment for the 6-month period under review
693	693	14 as identified in subparagraph (A).
694	694	15 (h) Fixed rate directed payments. Effective July 1, 2020,
695	695	16 the Department shall issue payments to MCOs which shall be
696	696	17 used to issue directed payments to Illinois hospitals not
697	697	18 identified in paragraph (g) on a monthly basis. Prior to the
698	698	19 beginning of each Payout Quarter beginning July 1, 2020, the
699	699	20 Department shall use encounter claims data from the
700	700	21 Determination Quarter, accepted by the Department's Medicaid
701	701	22 Management Information System for inpatient and outpatient
702	702	23 services rendered by hospitals in each hospital class
703	703	24 identified in paragraph (f) and not identified in paragraph
704	704	25 (g). For the period July 1, 2020 through December 2020, the
705	705	26 Department shall direct MCOs to make payments as follows:
706	706
707	707
708	708
709	709
710	710
711	711	HB3220 - 19 - LRB103 29689 KTG 56093 b
712	712
713	713
714	714	HB3220- 20 -LRB103 29689 KTG 56093 b HB3220 - 20 - LRB103 29689 KTG 56093 b
715	715	HB3220 - 20 - LRB103 29689 KTG 56093 b
716	716	1 (1) For general acute care hospitals an amount equal
717	717	2 to $1,750 multiplied by the hospital's category of service
718	718	3 20 case mix index for the determination quarter multiplied
719	719	4 by the hospital's total number of inpatient admissions for
720	720	5 category of service 20 for the determination quarter.
721	721	6 (2) For general acute care hospitals an amount equal
722	722	7 to $160 multiplied by the hospital's category of service
723	723	8 21 case mix index for the determination quarter multiplied
724	724	9 by the hospital's total number of inpatient admissions for
725	725	10 category of service 21 for the determination quarter.
726	726	11 (3) For general acute care hospitals an amount equal
727	727	12 to $80 multiplied by the hospital's category of service 22
728	728	13 case mix index for the determination quarter multiplied by
729	729	14 the hospital's total number of inpatient admissions for
730	730	15 category of service 22 for the determination quarter.
731	731	16 (4) For general acute care hospitals an amount equal
732	732	17 to $375 multiplied by the hospital's category of service
733	733	18 24 case mix index for the determination quarter multiplied
734	734	19 by the hospital's total number of category of service 24
735	735	20 paid EAPG (EAPGs) for the determination quarter.
736	736	21 (5) For general acute care hospitals an amount equal
737	737	22 to $240 multiplied by the hospital's category of service
738	738	23 27 and 28 case mix index for the determination quarter
739	739	24 multiplied by the hospital's total number of category of
740	740	25 service 27 and 28 paid EAPGs for the determination
741	741	26 quarter.
742	742
743	743
744	744
745	745
746	746
747	747	HB3220 - 20 - LRB103 29689 KTG 56093 b
748	748
749	749
750	750	HB3220- 21 -LRB103 29689 KTG 56093 b HB3220 - 21 - LRB103 29689 KTG 56093 b
751	751	HB3220 - 21 - LRB103 29689 KTG 56093 b
752	752	1 (6) For general acute care hospitals an amount equal
753	753	2 to $290 multiplied by the hospital's category of service
754	754	3 29 case mix index for the determination quarter multiplied
755	755	4 by the hospital's total number of category of service 29
756	756	5 paid EAPGs for the determination quarter.
757	757	6 (7) For high Medicaid hospitals an amount equal to
758	758	7 $1,800 multiplied by the hospital's category of service 20
759	759	8 case mix index for the determination quarter multiplied by
760	760	9 the hospital's total number of inpatient admissions for
761	761	10 category of service 20 for the determination quarter.
762	762	11 (8) For high Medicaid hospitals an amount equal to
763	763	12 $160 multiplied by the hospital's category of service 21
764	764	13 case mix index for the determination quarter multiplied by
765	765	14 the hospital's total number of inpatient admissions for
766	766	15 category of service 21 for the determination quarter.
767	767	16 (9) For high Medicaid hospitals an amount equal to $80
768	768	17 multiplied by the hospital's category of service 22 case
769	769	18 mix index for the determination quarter multiplied by the
770	770	19 hospital's total number of inpatient admissions for
771	771	20 category of service 22 for the determination quarter.
772	772	21 (10) For high Medicaid hospitals an amount equal to
773	773	22 $400 multiplied by the hospital's category of service 24
774	774	23 case mix index for the determination quarter multiplied by
775	775	24 the hospital's total number of category of service 24 paid
776	776	25 EAPG outpatient claims for the determination quarter.
777	777	26 (11) For high Medicaid hospitals an amount equal to
778	778
779	779
780	780
781	781
782	782
783	783	HB3220 - 21 - LRB103 29689 KTG 56093 b
784	784
785	785
786	786	HB3220- 22 -LRB103 29689 KTG 56093 b HB3220 - 22 - LRB103 29689 KTG 56093 b
787	787	HB3220 - 22 - LRB103 29689 KTG 56093 b
788	788	1 $240 multiplied by the hospital's category of service 27
789	789	2 and 28 case mix index for the determination quarter
790	790	3 multiplied by the hospital's total number of category of
791	791	4 service 27 and 28 paid EAPGs for the determination
792	792	5 quarter.
793	793	6 (12) For high Medicaid hospitals an amount equal to
794	794	7 $290 multiplied by the hospital's category of service 29
795	795	8 case mix index for the determination quarter multiplied by
796	796	9 the hospital's total number of category of service 29 paid
797	797	10 EAPGs for the determination quarter.
798	798	11 (13) For long term acute care hospitals the amount of
799	799	12 $495 multiplied by the hospital's total number of
800	800	13 inpatient days for the determination quarter.
801	801	14 (14) For psychiatric hospitals the amount of $210
802	802	15 multiplied by the hospital's total number of inpatient
803	803	16 days for category of service 21 for the determination
804	804	17 quarter.
805	805	18 (15) For psychiatric hospitals the amount of $250
806	806	19 multiplied by the hospital's total number of outpatient
807	807	20 claims for category of service 27 and 28 for the
808	808	21 determination quarter.
809	809	22 (16) For rehabilitation hospitals the amount of $410
810	810	23 multiplied by the hospital's total number of inpatient
811	811	24 days for category of service 22 for the determination
812	812	25 quarter.
813	813	26 (17) For rehabilitation hospitals the amount of $100
814	814
815	815
816	816
817	817
818	818
819	819	HB3220 - 22 - LRB103 29689 KTG 56093 b
820	820
821	821
822	822	HB3220- 23 -LRB103 29689 KTG 56093 b HB3220 - 23 - LRB103 29689 KTG 56093 b
823	823	HB3220 - 23 - LRB103 29689 KTG 56093 b
824	824	1 multiplied by the hospital's total number of outpatient
825	825	2 claims for category of service 29 for the determination
826	826	3 quarter.
827	827	4 (18) Effective for the Payout Quarter beginning
828	828	5 January 1, 2023, for the directed payments to hospitals
829	829	6 required under this subsection, the Department shall
830	830	7 establish the amounts that shall be used to calculate such
831	831	8 directed payments using the methodologies specified in
832	832	9 this paragraph. The Department shall use a single, uniform
833	833	10 rate, adjusted for acuity as specified in paragraphs (1)
834	834	11 through (12), for all categories of inpatient services
835	835	12 provided by each class of hospitals and a single uniform
836	836	13 rate, adjusted for acuity as specified in paragraphs (1)
837	837	14 through (12), for all categories of outpatient services
838	838	15 provided by each class of hospitals. The Department shall
839	839	16 establish such amounts so that the total amount of
840	840	17 payments to each hospital under this Section in calendar
841	841	18 year 2023 is projected to be substantially similar to the
842	842	19 total amount of such payments received by the hospital
843	843	20 under this Section in calendar year 2021, adjusted for
844	844	21 increased funding provided for fixed pool directed
845	845	22 payments under subsection (g) in calendar year 2022,
846	846	23 assuming that the volume and acuity of claims are held
847	847	24 constant. The Department shall publish the directed
848	848	25 payment amounts to be established under this subsection on
849	849	26 its website by November 15, 2022.
850	850
851	851
852	852
853	853
854	854
855	855	HB3220 - 23 - LRB103 29689 KTG 56093 b
856	856
857	857
858	858	HB3220- 24 -LRB103 29689 KTG 56093 b HB3220 - 24 - LRB103 29689 KTG 56093 b
859	859	HB3220 - 24 - LRB103 29689 KTG 56093 b
860	860	1 (19) Each hospital shall be paid 1/3 of their
861	861	2 quarterly inpatient and outpatient directed payment in
862	862	3 each of the 3 months of the Payout Quarter, in accordance
863	863	4 with directions provided to each MCO by the Department.
864	864	5 20 Each MCO shall pay each hospital the Monthly
865	865	6 Directed Payment amount as identified by the Department on
866	866	7 its quarterly determination report.
867	867	8 Notwithstanding any other provision of this subsection, if
868	868	9 the Department determines that the actual total hospital
869	869	10 utilization data that is used to calculate the fixed rate
870	870	11 directed payments is substantially different than anticipated
871	871	12 when the rates in this subsection were initially determined
872	872	13 for unforeseeable circumstances (such as the COVID-19 pandemic
873	873	14 or some other public health emergency), the Department may
874	874	15 adjust the rates specified in this subsection so that the
875	875	16 total directed payments approximate the total spending amount
876	876	17 anticipated when the rates were initially established.
877	877	18 Definitions. As used in this subsection:
878	878	19 (A) "Payout Quarter" means each calendar quarter,
879	879	20 beginning July 1, 2020.
880	880	21 (B) "Determination Quarter" means each calendar
881	881	22 quarter which ends 3 months prior to the first day of
882	882	23 each Payout Quarter.
883	883	24 (C) "Case mix index" means a hospital specific
884	884	25 calculation. For inpatient claims the case mix index
885	885	26 is calculated each quarter by summing the relative
886	886
887	887
888	888
889	889
890	890
891	891	HB3220 - 24 - LRB103 29689 KTG 56093 b
892	892
893	893
894	894	HB3220- 25 -LRB103 29689 KTG 56093 b HB3220 - 25 - LRB103 29689 KTG 56093 b
895	895	HB3220 - 25 - LRB103 29689 KTG 56093 b
896	896	1 weight of all inpatient Diagnosis-Related Group (DRG)
897	897	2 claims for a category of service in the applicable
898	898	3 Determination Quarter and dividing the sum by the
899	899	4 number of sum total of all inpatient DRG admissions
900	900	5 for the category of service for the associated claims.
901	901	6 The case mix index for outpatient claims is calculated
902	902	7 each quarter by summing the relative weight of all
903	903	8 paid EAPGs in the applicable Determination Quarter and
904	904	9 dividing the sum by the sum total of paid EAPGs for the
905	905	10 associated claims.
906	906	11 (i) Beginning January 1, 2021, the rates for directed
907	907	12 payments shall be recalculated in order to spend the
908	908	13 additional funds for directed payments that result from
909	909	14 reduction in the amount of pass-through payments allowed under
910	910	15 federal regulations. The additional funds for directed
911	911	16 payments shall be allocated proportionally to each class of
912	912	17 hospitals based on that class' proportion of services.
913	913	18 (1) Beginning January 1, 2024, the fixed pool directed
914	914	19 payment amounts and the associated annual initial rates
915	915	20 referenced in paragraph (6) of subsection (f) for each
916	916	21 hospital class shall be uniformly increased by a ratio of
917	917	22 not less than, the ratio of the total pass-through
918	918	23 reduction amount pursuant to paragraph (4) of subsection
919	919	24 (j), for the hospitals comprising the hospital fixed pool
920	920	25 directed payment class for the next calendar year, to the
921	921	26 total inpatient and outpatient directed payments for the
922	922
923	923
924	924
925	925
926	926
927	927	HB3220 - 25 - LRB103 29689 KTG 56093 b
928	928
929	929
930	930	HB3220- 26 -LRB103 29689 KTG 56093 b HB3220 - 26 - LRB103 29689 KTG 56093 b
931	931	HB3220 - 26 - LRB103 29689 KTG 56093 b
932	932	1 hospitals comprising the hospital fixed pool directed
933	933	2 payment class paid during the preceding calendar year.
934	934	3 (2) Beginning January 1, 2024, the fixed rates for the
935	935	4 directed payments referenced in paragraph (18) of
936	936	5 subsection (h) for each hospital class shall be uniformly
937	937	6 increased by a ratio of not less than, the ratio of the
938	938	7 total pass-through reduction amount pursuant to paragraph
939	939	8 (4) of subsection (j), for the hospitals comprising the
940	940	9 hospital directed payment class for the next calendar
941	941	10 year, to the total inpatient and outpatient directed
942	942	11 payments for the hospitals comprising the hospital fixed
943	943	12 rate directed payment class paid during the preceding
944	944	13 calendar year.
945	945	14 (j) Pass-through payments.
946	946	15 (1) For the period July 1, 2020 through December 31,
947	947	16 2020, the Department shall assign quarterly pass-through
948	948	17 payments to each class of hospitals equal to one-fourth of
949	949	18 the following annual allocations:
950	950	19 (A) $390,487,095 to safety-net hospitals.
951	951	20 (B) $62,553,886 to critical access hospitals.
952	952	21 (C) $345,021,438 to high Medicaid hospitals.
953	953	22 (D) $551,429,071 to general acute care hospitals.
954	954	23 (E) $27,283,870 to long term acute care hospitals.
955	955	24 (F) $40,825,444 to freestanding psychiatric
956	956	25 hospitals.
957	957	26 (G) $9,652,108 to freestanding rehabilitation
958	958
959	959
960	960
961	961
962	962
963	963	HB3220 - 26 - LRB103 29689 KTG 56093 b
964	964
965	965
966	966	HB3220- 27 -LRB103 29689 KTG 56093 b HB3220 - 27 - LRB103 29689 KTG 56093 b
967	967	HB3220 - 27 - LRB103 29689 KTG 56093 b
968	968	1 hospitals.
969	969	2 (2) For the period of July 1, 2020 through December
970	970	3 31, 2020, the pass-through payments shall at a minimum
971	971	4 ensure hospitals receive a total amount of monthly
972	972	5 payments under this Section as received in calendar year
973	973	6 2019 in accordance with this Article and paragraph (1) of
974	974	7 subsection (d-5) of Section 14-12, exclusive of amounts
975	975	8 received through payments referenced in subsection (b).
976	976	9 (3) For the calendar year beginning January 1, 2023,
977	977	10 the Department shall establish the annual pass-through
978	978	11 allocation to each class of hospitals and the pass-through
979	979	12 payments to each hospital so that the total amount of
980	980	13 payments to each hospital under this Section in calendar
981	981	14 year 2023 is projected to be substantially similar to the
982	982	15 total amount of such payments received by the hospital
983	983	16 under this Section in calendar year 2021, adjusted for
984	984	17 increased funding provided for fixed pool directed
985	985	18 payments under subsection (g) in calendar year 2022,
986	986	19 assuming that the volume and acuity of claims are held
987	987	20 constant. The Department shall publish the pass-through
988	988	21 allocation to each class and the pass-through payments to
989	989	22 each hospital to be established under this subsection on
990	990	23 its website by November 15, 2022.
991	991	24 (4) For the calendar years beginning January 1, 2021,
992	992	25 January 1, 2022, and January 1, 2024, and each calendar
993	993	26 year thereafter, each hospital's pass-through payment
994	994
995	995
996	996
997	997
998	998
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1000	1000
1001	1001
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1004	1004	1 amount shall be reduced proportionally to the reduction of
1005	1005	2 all pass-through payments required by federal regulations.
1006	1006	3 (k) At least 30 days prior to each calendar year, the
1007	1007	4 Department shall notify each hospital of changes to the
1008	1008	5 payment methodologies in this Section, including, but not
1009	1009	6 limited to, changes in the fixed rate directed payment rates,
1010	1010	7 the aggregate pass-through payment amount for all hospitals,
1011	1011	8 and the hospital's pass-through payment amount for the
1012	1012	9 upcoming calendar year.
1013	1013	10 (l) Notwithstanding any other provisions of this Section,
1014	1014	11 the Department may adopt rules to change the methodology for
1015	1015	12 directed and pass-through payments as set forth in this
1016	1016	13 Section, but only to the extent necessary to obtain federal
1017	1017	14 approval of a necessary State Plan amendment or Directed
1018	1018	15 Payment Preprint or to otherwise conform to federal law or
1019	1019	16 federal regulation.
1020	1020	17 (m) As used in this subsection, "managed care
1021	1021	18 organization" or "MCO" means an entity which contracts with
1022	1022	19 the Department to provide services where payment for medical
1023	1023	20 services is made on a capitated basis, excluding contracted
1024	1024	21 entities for dual eligible or Department of Children and
1025	1025	22 Family Services youth populations.
1026	1026	23 (n) In order to address the escalating infant mortality
1027	1027	24 rates among minority communities in Illinois, the State shall,
1028	1028	25 subject to appropriation, create a pool of funding of at least
1029	1029	26 $55,000,000 $50,000,000 annually to be disbursed among
1030	1030
1031	1031
1032	1032
1033	1033
1034	1034
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1036	1036
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1040	1040	1 safety-net hospitals that maintain perinatal designation from
1041	1041	2 the Department of Public Health. The funding shall be used to
1042	1042	3 preserve or enhance OB/GYN services or other specialty
1043	1043	4 services at the receiving hospital, with the distribution of
1044	1044	5 funding to be established by rule and with consideration to
1045	1045	6 perinatal hospitals with safe birthing levels and quality
1046	1046	7 metrics for healthy mothers and babies. In addition,
1047	1047	8 $5,000,000 of this amount shall be disbursed to non-safety net
1048	1048	9 hospitals that serve at least 44% Medicaid patients and handle
1049	1049	10 a minimum of 1,000 births per year and are designated by the
1050	1050	11 Department of Public Health as perinatal level III hospitals
1051	1051	12 to maintain access to such services for Medicaid eligible
1052	1052	13 mothers and babies.
1053	1053	14 (o) In order to address the growing challenges of
1054	1054	15 providing stable access to healthcare in rural Illinois,
1055	1055	16 including perinatal services, behavioral healthcare including
1056	1056	17 substance use disorder services (SUDs) and other specialty
1057	1057	18 services, and to expand access to telehealth services among
1058	1058	19 rural communities in Illinois, the Department of Healthcare
1059	1059	20 and Family Services, subject to appropriation, shall
1060	1060	21 administer a program to provide at least $10,000,000 in
1061	1061	22 financial support annually to critical access hospitals for
1062	1062	23 delivery of perinatal and OB/GYN services, behavioral
1063	1063	24 healthcare including SUDS, other specialty services and
1064	1064	25 telehealth services. The funding shall be used to preserve or
1065	1065	26 enhance perinatal and OB/GYN services, behavioral healthcare
1066	1066
1067	1067
1068	1068
1069	1069
1070	1070
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1072	1072
1073	1073
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1076	1076	1 including SUDS, other specialty services, as well as the
1077	1077	2 explanation of telehealth services by the receiving hospital,
1078	1078	3 with the distribution of funding to be established by rule.
1079	1079	4 (p) For calendar year 2023, the final amounts, rates, and
1080	1080	5 payments under subsections (c), (d-2), (g), (h), and (j) shall
1081	1081	6 be established by the Department, so that the sum of the total
1082	1082	7 estimated annual payments under subsections (c), (d-2), (g),
1083	1083	8 (h), and (j) for each hospital class for calendar year 2023, is
1084	1084	9 no less than:
1085	1085	10 (1) $858,260,000 to safety-net hospitals.
1086	1086	11 (2) $86,200,000 to critical access hospitals.
1087	1087	12 (3) $1,765,000,000 to high Medicaid hospitals.
1088	1088	13 (4) $673,860,000 to general acute care hospitals.
1089	1089	14 (5) $48,330,000 to long term acute care hospitals.
1090	1090	15 (6) $89,110,000 to freestanding psychiatric hospitals.
1091	1091	16 (7) $24,300,000 to freestanding rehabilitation
1092	1092	17 hospitals.
1093	1093	18 (8) $32,570,000 to public hospitals.
1094	1094	19 (q) Hospital Pandemic Recovery Stabilization Payments. The
1095	1095	20 Department shall disburse a pool of $460,000,000 in stability
1096	1096	21 payments to hospitals prior to April 1, 2023. The allocation
1097	1097	22 of the pool shall be based on the hospital directed payment
1098	1098	23 classes and directed payments issued, during Calendar Year
1099	1099	24 2022 with added consideration to safety net hospitals, as
1100	1100	25 defined in subdivision (f)(1)(B) of this Section, and critical
1101	1101	26 access hospitals.
1102	1102
1103	1103
1104	1104
1105	1105
1106	1106
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1108	1108
1109	1109
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1111	1111	HB3220 - 31 - LRB103 29689 KTG 56093 b
1112	1112	1 (Source: P.A. 101-650, eff. 7-7-20; 102-4, eff. 4-27-21;
1113	1113	2 102-16, eff. 6-17-21; 102-886, eff. 5-17-22; 102-1115, eff.
1114	1114	3 1-9-23.)
1115	1115
1116	1116
1117	1117
1118	1118
1119	1119
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