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
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
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
LRB103 29689 KTG 56093 b
A BILL FOR
HB3220LRB103 29689 KTG 56093 b HB3220 LRB103 29689 KTG 56093 b
HB3220 LRB103 29689 KTG 56093 b
1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
4 Section 5. The Illinois Public Aid Code is amended by
5 changing Section 5A-12.7 as follows:
6 (305 ILCS 5/5A-12.7)
7 (Section scheduled to be repealed on December 31, 2026)
8 Sec. 5A-12.7. Continuation of hospital access payments on
9 and after July 1, 2020.
10 (a) To preserve and improve access to hospital services,
11 for hospital services rendered on and after July 1, 2020, the
12 Department shall, except for hospitals described in subsection
13 (b) of Section 5A-3, make payments to hospitals or require
14 capitated managed care organizations to make payments as set
15 forth in this Section. Payments under this Section are not due
16 and payable, however, until: (i) the methodologies described
17 in this Section are approved by the federal government in an
18 appropriate State Plan amendment or directed payment preprint;
19 and (ii) the assessment imposed under this Article is
20 determined to be a permissible tax under Title XIX of the
21 Social Security Act. In determining the hospital access
22 payments authorized under subsection (g) of this Section, if a
23 hospital ceases to qualify for payments from the pool, the
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
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
LRB103 29689 KTG 56093 b
A BILL FOR
305 ILCS 5/5A-12.7
LRB103 29689 KTG 56093 b
HB3220 LRB103 29689 KTG 56093 b
HB3220- 2 -LRB103 29689 KTG 56093 b HB3220 - 2 - LRB103 29689 KTG 56093 b
HB3220 - 2 - LRB103 29689 KTG 56093 b
1 payments for all hospitals continuing to qualify for payments
2 from such pool shall be uniformly adjusted to fully expend the
3 aggregate net amount of the pool, with such adjustment being
4 effective on the first day of the second month following the
5 date the hospital ceases to receive payments from such pool.
6 (b) Amounts moved into claims-based rates and distributed
7 in accordance with Section 14-12 shall remain in those
8 claims-based rates.
9 (c) Graduate medical education.
10 (1) The calculation of graduate medical education
11 payments shall be based on the hospital's Medicare cost
12 report ending in Calendar Year 2018, as reported in the
13 Healthcare Cost Report Information System file, release
14 date September 30, 2019. An Illinois hospital reporting
15 intern and resident cost on its Medicare cost report shall
16 be eligible for graduate medical education payments.
17 (2) Each hospital's annualized Medicaid Intern
18 Resident Cost is calculated using annualized intern and
19 resident total costs obtained from Worksheet B Part I,
20 Columns 21 and 22 the sum of Lines 30-43, 50-76, 90-93,
21 96-98, and 105-112 multiplied by the percentage that the
22 hospital's Medicaid days (Worksheet S3 Part I, Column 7,
23 Lines 2, 3, 4, 14, 16-18, and 32) comprise of the
24 hospital's total days (Worksheet S3 Part I, Column 8,
25 Lines 14, 16-18, and 32).
26 (3) An annualized Medicaid indirect medical education
HB3220 - 2 - LRB103 29689 KTG 56093 b
HB3220- 3 -LRB103 29689 KTG 56093 b HB3220 - 3 - LRB103 29689 KTG 56093 b
HB3220 - 3 - LRB103 29689 KTG 56093 b
1 (IME) payment is calculated for each hospital using its
2 IME payments (Worksheet E Part A, Line 29, Column 1)
3 multiplied by the percentage that its Medicaid days
4 (Worksheet S3 Part I, Column 7, Lines 2, 3, 4, 14, 16-18,
5 and 32) comprise of its Medicare days (Worksheet S3 Part
6 I, Column 6, Lines 2, 3, 4, 14, and 16-18).
7 (4) For each hospital, its annualized Medicaid Intern
8 Resident Cost and its annualized Medicaid IME payment are
9 summed, and, except as capped at 120% of the average cost
10 per intern and resident for all qualifying hospitals as
11 calculated under this paragraph, is multiplied by the
12 applicable reimbursement factor as described in this
13 paragraph, to determine the hospital's final graduate
14 medical education payment. Each hospital's average cost
15 per intern and resident shall be calculated by summing its
16 total annualized Medicaid Intern Resident Cost plus its
17 annualized Medicaid IME payment and dividing that amount
18 by the hospital's total Full Time Equivalent Residents and
19 Interns. If the hospital's average per intern and resident
20 cost is greater than 120% of the same calculation for all
21 qualifying hospitals, the hospital's per intern and
22 resident cost shall be capped at 120% of the average cost
23 for all qualifying hospitals.
24 (A) For the period of July 1, 2020 through
25 December 31, 2022, the applicable reimbursement factor
26 shall be 22.6%.
HB3220 - 3 - LRB103 29689 KTG 56093 b
HB3220- 4 -LRB103 29689 KTG 56093 b HB3220 - 4 - LRB103 29689 KTG 56093 b
HB3220 - 4 - LRB103 29689 KTG 56093 b
1 (B) For the period of January 1, 2023 through
2 December 31, 2026, the applicable reimbursement factor
3 shall be 35% for all qualified safety-net hospitals,
4 as defined in Section 5-5e.1 of this Code, and all
5 hospitals with 100 or more Full Time Equivalent
6 Residents and Interns, as reported on the hospital's
7 Medicare cost report ending in Calendar Year 2018, and
8 for all other qualified hospitals the applicable
9 reimbursement factor shall be 30%.
10 (d) Fee-for-service supplemental payments. For the period
11 of July 1, 2020 through December 31, 2022, each Illinois
12 hospital shall receive an annual payment equal to the amounts
13 below, to be paid in 12 equal installments on or before the
14 seventh State business day of each month, except that no
15 payment shall be due within 30 days after the later of the date
16 of notification of federal approval of the payment
17 methodologies required under this Section or any waiver
18 required under 42 CFR 433.68, at which time the sum of amounts
19 required under this Section prior to the date of notification
20 is due and payable.
21 (1) For critical access hospitals, $385 per covered
22 inpatient day contained in paid fee-for-service claims and
23 $530 per paid fee-for-service outpatient claim for dates
24 of service in Calendar Year 2019 in the Department's
25 Enterprise Data Warehouse as of May 11, 2020.
26 (2) For safety-net hospitals, $960 per covered
HB3220 - 4 - LRB103 29689 KTG 56093 b
HB3220- 5 -LRB103 29689 KTG 56093 b HB3220 - 5 - LRB103 29689 KTG 56093 b
HB3220 - 5 - LRB103 29689 KTG 56093 b
1 inpatient day contained in paid fee-for-service claims and
2 $625 per paid fee-for-service outpatient claim for dates
3 of service in Calendar Year 2019 in the Department's
4 Enterprise Data Warehouse as of May 11, 2020.
5 (3) For long term acute care hospitals, $295 per
6 covered inpatient day contained in paid fee-for-service
7 claims for dates of service in Calendar Year 2019 in the
8 Department's Enterprise Data Warehouse as of May 11, 2020.
9 (4) For freestanding psychiatric hospitals, $125 per
10 covered inpatient day contained in paid fee-for-service
11 claims and $130 per paid fee-for-service outpatient claim
12 for dates of service in Calendar Year 2019 in the
13 Department's Enterprise Data Warehouse as of May 11, 2020.
14 (5) For freestanding rehabilitation hospitals, $355
15 per covered inpatient day contained in paid
16 fee-for-service claims for dates of service in Calendar
17 Year 2019 in the Department's Enterprise Data Warehouse as
18 of May 11, 2020.
19 (6) For all general acute care hospitals and high
20 Medicaid hospitals as defined in subsection (f), $350 per
21 covered inpatient day for dates of service in Calendar
22 Year 2019 contained in paid fee-for-service claims and
23 $620 per paid fee-for-service outpatient claim in the
24 Department's Enterprise Data Warehouse as of May 11, 2020.
25 (7) Alzheimer's treatment access payment. Each
26 Illinois academic medical center or teaching hospital, as
HB3220 - 5 - LRB103 29689 KTG 56093 b
HB3220- 6 -LRB103 29689 KTG 56093 b HB3220 - 6 - LRB103 29689 KTG 56093 b
HB3220 - 6 - LRB103 29689 KTG 56093 b
1 defined in Section 5-5e.2 of this Code, that is identified
2 as the primary hospital affiliate of one of the Regional
3 Alzheimer's Disease Assistance Centers, as designated by
4 the Alzheimer's Disease Assistance Act and identified in
5 the Department of Public Health's Alzheimer's Disease
6 State Plan dated December 2016, shall be paid an
7 Alzheimer's treatment access payment equal to the product
8 of the qualifying hospital's State Fiscal Year 2018 total
9 inpatient fee-for-service days multiplied by the
10 applicable Alzheimer's treatment rate of $226.30 for
11 hospitals located in Cook County and $116.21 for hospitals
12 located outside Cook County.
13 (d-2) Fee-for-service supplemental payments. Beginning
14 January 1, 2023, each Illinois hospital shall receive an
15 annual payment equal to the amounts listed below, to be paid in
16 12 equal installments on or before the seventh State business
17 day of each month, except that no payment shall be due within
18 30 days after the later of the date of notification of federal
19 approval of the payment methodologies required under this
20 Section or any waiver required under 42 CFR 433.68, at which
21 time the sum of amounts required under this Section prior to
22 the date of notification is due and payable. The Department
23 may adjust the rates in paragraphs (1) through (7) to comply
24 with the federal upper payment limits, with such adjustments
25 being determined so that the total estimated spending by
26 hospital class, under such adjusted rates, remains
HB3220 - 6 - LRB103 29689 KTG 56093 b
HB3220- 7 -LRB103 29689 KTG 56093 b HB3220 - 7 - LRB103 29689 KTG 56093 b
HB3220 - 7 - LRB103 29689 KTG 56093 b
1 substantially similar to the total estimated spending under
2 the original rates set forth in this subsection.
3 (1) For critical access hospitals, as defined in
4 subsection (f), $750 per covered inpatient day contained
5 in paid fee-for-service claims and $750 per paid
6 fee-for-service outpatient claim for dates of service in
7 Calendar Year 2019 in the Department's Enterprise Data
8 Warehouse as of August 6, 2021.
9 (2) For safety-net hospitals, as described in
10 subsection (f), $1,350 per inpatient day contained in paid
11 fee-for-service claims and $1,350 per paid fee-for-service
12 outpatient claim for dates of service in Calendar Year
13 2019 in the Department's Enterprise Data Warehouse as of
14 August 6, 2021.
15 (3) For long term acute care hospitals, $550 per
16 covered inpatient day contained in paid fee-for-service
17 claims for dates of service in Calendar Year 2019 in the
18 Department's Enterprise Data Warehouse as of August 6,
19 2021.
20 (4) For freestanding psychiatric hospitals, $200 per
21 covered inpatient day contained in paid fee-for-service
22 claims and $200 per paid fee-for-service outpatient claim
23 for dates of service in Calendar Year 2019 in the
24 Department's Enterprise Data Warehouse as of August 6,
25 2021.
26 (5) For freestanding rehabilitation hospitals, $550
HB3220 - 7 - LRB103 29689 KTG 56093 b
HB3220- 8 -LRB103 29689 KTG 56093 b HB3220 - 8 - LRB103 29689 KTG 56093 b
HB3220 - 8 - LRB103 29689 KTG 56093 b
1 per covered inpatient day contained in paid
2 fee-for-service claims and $125 per paid fee-for-service
3 outpatient claim for dates of service in Calendar Year
4 2019 in the Department's Enterprise Data Warehouse as of
5 August 6, 2021.
6 (6) For all general acute care hospitals and high
7 Medicaid hospitals as defined in subsection (f), $500 per
8 covered inpatient day for dates of service in Calendar
9 Year 2019 contained in paid fee-for-service claims and
10 $500 per paid fee-for-service outpatient claim in the
11 Department's Enterprise Data Warehouse as of August 6,
12 2021.
13 (7) For public hospitals, as defined in subsection
14 (f), $275 per covered inpatient day contained in paid
15 fee-for-service claims and $275 per paid fee-for-service
16 outpatient claim for dates of service in Calendar Year
17 2019 in the Department's Enterprise Data Warehouse as of
18 August 6, 2021.
19 (8) Alzheimer's treatment access payment. Each
20 Illinois academic medical center or teaching hospital, as
21 defined in Section 5-5e.2 of this Code, that is identified
22 as the primary hospital affiliate of one of the Regional
23 Alzheimer's Disease Assistance Centers, as designated by
24 the Alzheimer's Disease Assistance Act and identified in
25 the Department of Public Health's Alzheimer's Disease
26 State Plan dated December 2016, shall be paid an
HB3220 - 8 - LRB103 29689 KTG 56093 b
HB3220- 9 -LRB103 29689 KTG 56093 b HB3220 - 9 - LRB103 29689 KTG 56093 b
HB3220 - 9 - LRB103 29689 KTG 56093 b
1 Alzheimer's treatment access payment equal to the product
2 of the qualifying hospital's Calendar Year 2019 total
3 inpatient fee-for-service days, in the Department's
4 Enterprise Data Warehouse as of August 6, 2021, multiplied
5 by the applicable Alzheimer's treatment rate of $244.37
6 for hospitals located in Cook County and $312.03 for
7 hospitals located outside Cook County.
8 (e) The Department shall require managed care
9 organizations (MCOs) to make directed payments and
10 pass-through payments according to this Section. Each calendar
11 year, the Department shall require MCOs to pay the maximum
12 amount out of these funds as allowed as pass-through payments
13 under federal regulations. The Department shall require MCOs
14 to make such pass-through payments as specified in this
15 Section. The Department shall require the MCOs to pay the
16 remaining amounts as directed Payments as specified in this
17 Section. The Department shall issue payments to the
18 Comptroller by the seventh business day of each month for all
19 MCOs that are sufficient for MCOs to make the directed
20 payments and pass-through payments according to this Section.
21 The Department shall require the MCOs to make pass-through
22 payments and directed payments using electronic funds
23 transfers (EFT), if the hospital provides the information
24 necessary to process such EFTs, in accordance with directions
25 provided monthly by the Department, within 7 business days of
26 the date the funds are paid to the MCOs, as indicated by the
HB3220 - 9 - LRB103 29689 KTG 56093 b
HB3220- 10 -LRB103 29689 KTG 56093 b HB3220 - 10 - LRB103 29689 KTG 56093 b
HB3220 - 10 - LRB103 29689 KTG 56093 b
1 "Paid Date" on the website of the Office of the Comptroller if
2 the funds are paid by EFT and the MCOs have received directed
3 payment instructions. If funds are not paid through the
4 Comptroller by EFT, payment must be made within 7 business
5 days of the date actually received by the MCO. The MCO will be
6 considered to have paid the pass-through payments when the
7 payment remittance number is generated or the date the MCO
8 sends the check to the hospital, if EFT information is not
9 supplied. If an MCO is late in paying a pass-through payment or
10 directed payment as required under this Section (including any
11 extensions granted by the Department), it shall pay a penalty,
12 unless waived by the Department for reasonable cause, to the
13 Department equal to 5% of the amount of the pass-through
14 payment or directed payment not paid on or before the due date
15 plus 5% of the portion thereof remaining unpaid on the last day
16 of each 30-day period thereafter. Payments to MCOs that would
17 be paid consistent with actuarial certification and enrollment
18 in the absence of the increased capitation payments under this
19 Section shall not be reduced as a consequence of payments made
20 under this subsection. The Department shall publish and
21 maintain on its website for a period of no less than 8 calendar
22 quarters, the quarterly calculation of directed payments and
23 pass-through payments owed to each hospital from each MCO. All
24 calculations and reports shall be posted no later than the
25 first day of the quarter for which the payments are to be
26 issued.
HB3220 - 10 - LRB103 29689 KTG 56093 b
HB3220- 11 -LRB103 29689 KTG 56093 b HB3220 - 11 - LRB103 29689 KTG 56093 b
HB3220 - 11 - LRB103 29689 KTG 56093 b
1 (f)(1) For purposes of allocating the funds included in
2 capitation payments to MCOs, Illinois hospitals shall be
3 divided into the following classes as defined in
4 administrative rules:
5 (A) Beginning July 1, 2020 through December 31, 2022,
6 critical access hospitals. Beginning January 1, 2023,
7 "critical access hospital" means a hospital designated by
8 the Department of Public Health as a critical access
9 hospital, excluding any hospital meeting the definition of
10 a public hospital in subparagraph (F).
11 (B) Safety-net hospitals, except that stand-alone
12 children's hospitals that are not specialty children's
13 hospitals will not be included. For the calendar year
14 beginning January 1, 2023, and each calendar year
15 thereafter, assignment to the safety-net class shall be
16 based on the annual safety-net rate year beginning 15
17 months before the beginning of the first Payout Quarter of
18 the calendar year.
19 (C) Long term acute care hospitals.
20 (D) Freestanding psychiatric hospitals.
21 (E) Freestanding rehabilitation hospitals.
22 (F) Beginning January 1, 2023, "public hospital" means
23 a hospital that is owned or operated by an Illinois
24 Government body or municipality, excluding a hospital
25 provider that is a State agency, a State university, or a
26 county with a population of 3,000,000 or more.
HB3220 - 11 - LRB103 29689 KTG 56093 b
HB3220- 12 -LRB103 29689 KTG 56093 b HB3220 - 12 - LRB103 29689 KTG 56093 b
HB3220 - 12 - LRB103 29689 KTG 56093 b
1 (G) High Medicaid hospitals.
2 (i) As used in this Section, "high Medicaid
3 hospital" means a general acute care hospital that:
4 (I) For the payout periods July 1, 2020
5 through December 31, 2022, is not a safety-net
6 hospital or critical access hospital and that has
7 a Medicaid Inpatient Utilization Rate above 30% or
8 a hospital that had over 35,000 inpatient Medicaid
9 days during the applicable period. For the period
10 July 1, 2020 through December 31, 2020, the
11 applicable period for the Medicaid Inpatient
12 Utilization Rate (MIUR) is the rate year 2020 MIUR
13 and for the number of inpatient days it is State
14 fiscal year 2018. Beginning in calendar year 2021,
15 the Department shall use the most recently
16 determined MIUR, as defined in subsection (h) of
17 Section 5-5.02, and for the inpatient day
18 threshold, the State fiscal year ending 18 months
19 prior to the beginning of the calendar year. For
20 purposes of calculating MIUR under this Section,
21 children's hospitals and affiliated general acute
22 care hospitals shall be considered a single
23 hospital.
24 (II) For the calendar year beginning January
25 1, 2023, and each calendar year thereafter, is not
26 a public hospital, safety-net hospital, or
HB3220 - 12 - LRB103 29689 KTG 56093 b
HB3220- 13 -LRB103 29689 KTG 56093 b HB3220 - 13 - LRB103 29689 KTG 56093 b
HB3220 - 13 - LRB103 29689 KTG 56093 b
1 critical access hospital and that qualifies as a
2 regional high volume hospital or is a hospital
3 that has a Medicaid Inpatient Utilization Rate
4 (MIUR) above 30%. As used in this item, "regional
5 high volume hospital" means a hospital which ranks
6 in the top 2 quartiles based on total hospital
7 services volume, of all eligible general acute
8 care hospitals, when ranked in descending order
9 based on total hospital services volume, within
10 the same Medicaid managed care region, as
11 designated by the Department, as of January 1,
12 2022. As used in this item, "total hospital
13 services volume" means the total of all Medical
14 Assistance hospital inpatient admissions plus all
15 Medical Assistance hospital outpatient visits. For
16 purposes of determining regional high volume
17 hospital inpatient admissions and outpatient
18 visits, the Department shall use dates of service
19 provided during State Fiscal Year 2020 for the
20 Payout Quarter beginning January 1, 2023. The
21 Department shall use dates of service from the
22 State fiscal year ending 18 month before the
23 beginning of the first Payout Quarter of the
24 subsequent annual determination period.
25 (ii) For the calendar year beginning January 1,
26 2023, the Department shall use the Rate Year 2022
HB3220 - 13 - LRB103 29689 KTG 56093 b
HB3220- 14 -LRB103 29689 KTG 56093 b HB3220 - 14 - LRB103 29689 KTG 56093 b
HB3220 - 14 - LRB103 29689 KTG 56093 b
1 Medicaid inpatient utilization rate (MIUR), as defined
2 in subsection (h) of Section 5-5.02. For each
3 subsequent annual determination, the Department shall
4 use the MIUR applicable to the rate year ending
5 September 30 of the year preceding the beginning of
6 the calendar year.
7 (H) General acute care hospitals. As used under this
8 Section, "general acute care hospitals" means all other
9 Illinois hospitals not identified in subparagraphs (A)
10 through (G).
11 (2) Hospitals' qualification for each class shall be
12 assessed prior to the beginning of each calendar year and the
13 new class designation shall be effective January 1 of the next
14 year. The Department shall publish by rule the process for
15 establishing class determination.
16 (g) Fixed pool directed payments. Beginning July 1, 2020,
17 the Department shall issue payments to MCOs which shall be
18 used to issue directed payments to qualified Illinois
19 safety-net hospitals and critical access hospitals on a
20 monthly basis in accordance with this subsection. Prior to the
21 beginning of each Payout Quarter beginning July 1, 2020, the
22 Department shall use encounter claims data from the
23 Determination Quarter, accepted by the Department's Medicaid
24 Management Information System for inpatient and outpatient
25 services rendered by safety-net hospitals and critical access
26 hospitals to determine a quarterly uniform per unit add-on for
HB3220 - 14 - LRB103 29689 KTG 56093 b
HB3220- 15 -LRB103 29689 KTG 56093 b HB3220 - 15 - LRB103 29689 KTG 56093 b
HB3220 - 15 - LRB103 29689 KTG 56093 b
1 each hospital class.
2 (1) Inpatient per unit add-on. A quarterly uniform per
3 diem add-on shall be derived by dividing the quarterly
4 Inpatient Directed Payments Pool amount allocated to the
5 applicable hospital class by the total inpatient days
6 contained on all encounter claims received during the
7 Determination Quarter, for all hospitals in the class.
8 (A) Each hospital in the class shall have a
9 quarterly inpatient directed payment calculated that
10 is equal to the product of the number of inpatient days
11 attributable to the hospital used in the calculation
12 of the quarterly uniform class per diem add-on,
13 multiplied by the calculated applicable quarterly
14 uniform class per diem add-on of the hospital class.
15 (B) Each hospital shall be paid 1/3 of its
16 quarterly inpatient directed payment in each of the 3
17 months of the Payout Quarter, in accordance with
18 directions provided to each MCO by the Department.
19 (2) Outpatient per unit add-on. A quarterly uniform
20 per claim add-on shall be derived by dividing the
21 quarterly Outpatient Directed Payments Pool amount
22 allocated to the applicable hospital class by the total
23 outpatient encounter claims received during the
24 Determination Quarter, for all hospitals in the class.
25 (A) Each hospital in the class shall have a
26 quarterly outpatient directed payment calculated that
HB3220 - 15 - LRB103 29689 KTG 56093 b
HB3220- 16 -LRB103 29689 KTG 56093 b HB3220 - 16 - LRB103 29689 KTG 56093 b
HB3220 - 16 - LRB103 29689 KTG 56093 b
1 is equal to the product of the number of outpatient
2 encounter claims attributable to the hospital used in
3 the calculation of the quarterly uniform class per
4 claim add-on, multiplied by the calculated applicable
5 quarterly uniform class per claim add-on of the
6 hospital class.
7 (B) Each hospital shall be paid 1/3 of its
8 quarterly outpatient directed payment in each of the 3
9 months of the Payout Quarter, in accordance with
10 directions provided to each MCO by the Department.
11 (3) Each MCO shall pay each hospital the Monthly
12 Directed Payment as identified by the Department on its
13 quarterly determination report.
14 (4) Definitions. As used in this subsection:
15 (A) "Payout Quarter" means each 3 month calendar
16 quarter, beginning July 1, 2020.
17 (B) "Determination Quarter" means each 3 month
18 calendar quarter, which ends 3 months prior to the
19 first day of each Payout Quarter.
20 (5) For the period July 1, 2020 through December 2020,
21 the following amounts shall be allocated to the following
22 hospital class directed payment pools for the quarterly
23 development of a uniform per unit add-on:
24 (A) $2,894,500 for hospital inpatient services for
25 critical access hospitals.
26 (B) $4,294,374 for hospital outpatient services
HB3220 - 16 - LRB103 29689 KTG 56093 b
HB3220- 17 -LRB103 29689 KTG 56093 b HB3220 - 17 - LRB103 29689 KTG 56093 b
HB3220 - 17 - LRB103 29689 KTG 56093 b
1 for critical access hospitals.
2 (C) $29,109,330 for hospital inpatient services
3 for safety-net hospitals.
4 (D) $35,041,218 for hospital outpatient services
5 for safety-net hospitals.
6 (6) For the period January 1, 2023 through December
7 31, 2023, the Department shall establish the amounts that
8 shall be allocated to the hospital class directed payment
9 fixed pools identified in this paragraph for the quarterly
10 development of a uniform per unit add-on. The Department
11 shall establish such amounts so that the total amount of
12 payments to each hospital under this Section in calendar
13 year 2023 is projected to be substantially similar to the
14 total amount of such payments received by the hospital
15 under this Section in calendar year 2021, adjusted for
16 increased funding provided for fixed pool directed
17 payments under subsection (g) in calendar year 2022,
18 assuming that the volume and acuity of claims are held
19 constant. The Department shall publish the directed
20 payment fixed pool amounts to be established under this
21 paragraph on its website by November 15, 2022.
22 (A) Hospital inpatient services for critical
23 access hospitals.
24 (B) Hospital outpatient services for critical
25 access hospitals.
26 (C) Hospital inpatient services for public
HB3220 - 17 - LRB103 29689 KTG 56093 b
HB3220- 18 -LRB103 29689 KTG 56093 b HB3220 - 18 - LRB103 29689 KTG 56093 b
HB3220 - 18 - LRB103 29689 KTG 56093 b
1 hospitals.
2 (D) Hospital outpatient services for public
3 hospitals.
4 (E) Hospital inpatient services for safety-net
5 hospitals.
6 (F) Hospital outpatient services for safety-net
7 hospitals.
8 (7) Semi-annual rate maintenance review. The
9 Department shall ensure that hospitals assigned to the
10 fixed pools in paragraph (6) are paid no less than 95% of
11 the annual initial rate for each 6-month period of each
12 annual payout period. For each calendar year, the
13 Department shall calculate the annual initial rate per day
14 and per visit for each fixed pool hospital class listed in
15 paragraph (6), by dividing the total of all applicable
16 inpatient or outpatient directed payments issued in the
17 preceding calendar year to the hospitals in each fixed
18 pool class for the calendar year, plus any increase
19 resulting from the annual adjustments described in
20 subsection (i), by the actual applicable total service
21 units for the preceding calendar year which were the basis
22 of the total applicable inpatient or outpatient directed
23 payments issued to the hospitals in each fixed pool class
24 in the calendar year, except that for calendar year 2023,
25 the service units from calendar year 2021 shall be used.
26 (A) The Department shall calculate the effective
HB3220 - 18 - LRB103 29689 KTG 56093 b
HB3220- 19 -LRB103 29689 KTG 56093 b HB3220 - 19 - LRB103 29689 KTG 56093 b
HB3220 - 19 - LRB103 29689 KTG 56093 b
1 rate, per day and per visit, for the payout periods of
2 January to June and July to December of each year, for
3 each fixed pool listed in paragraph (6), by dividing
4 50% of the annual pool by the total applicable
5 reported service units for the 2 applicable
6 determination quarters.
7 (B) If the effective rate calculated in
8 subparagraph (A) is less than 95% of the annual
9 initial rate assigned to the class for each pool under
10 paragraph (6), the Department shall adjust the payment
11 for each hospital to a level equal to no less than 95%
12 of the annual initial rate, by issuing a retroactive
13 adjustment payment for the 6-month period under review
14 as identified in subparagraph (A).
15 (h) Fixed rate directed payments. Effective July 1, 2020,
16 the Department shall issue payments to MCOs which shall be
17 used to issue directed payments to Illinois hospitals not
18 identified in paragraph (g) on a monthly basis. Prior to the
19 beginning of each Payout Quarter beginning July 1, 2020, the
20 Department shall use encounter claims data from the
21 Determination Quarter, accepted by the Department's Medicaid
22 Management Information System for inpatient and outpatient
23 services rendered by hospitals in each hospital class
24 identified in paragraph (f) and not identified in paragraph
25 (g). For the period July 1, 2020 through December 2020, the
26 Department shall direct MCOs to make payments as follows:
HB3220 - 19 - LRB103 29689 KTG 56093 b
HB3220- 20 -LRB103 29689 KTG 56093 b HB3220 - 20 - LRB103 29689 KTG 56093 b
HB3220 - 20 - LRB103 29689 KTG 56093 b
1 (1) For general acute care hospitals an amount equal
2 to $1,750 multiplied by the hospital's category of service
3 20 case mix index for the determination quarter multiplied
4 by the hospital's total number of inpatient admissions for
5 category of service 20 for the determination quarter.
6 (2) For general acute care hospitals an amount equal
7 to $160 multiplied by the hospital's category of service
8 21 case mix index for the determination quarter multiplied
9 by the hospital's total number of inpatient admissions for
10 category of service 21 for the determination quarter.
11 (3) For general acute care hospitals an amount equal
12 to $80 multiplied by the hospital's category of service 22
13 case mix index for the determination quarter multiplied by
14 the hospital's total number of inpatient admissions for
15 category of service 22 for the determination quarter.
16 (4) For general acute care hospitals an amount equal
17 to $375 multiplied by the hospital's category of service
18 24 case mix index for the determination quarter multiplied
19 by the hospital's total number of category of service 24
20 paid EAPG (EAPGs) for the determination quarter.
21 (5) For general acute care hospitals an amount equal
22 to $240 multiplied by the hospital's category of service
23 27 and 28 case mix index for the determination quarter
24 multiplied by the hospital's total number of category of
25 service 27 and 28 paid EAPGs for the determination
26 quarter.
HB3220 - 20 - LRB103 29689 KTG 56093 b
HB3220- 21 -LRB103 29689 KTG 56093 b HB3220 - 21 - LRB103 29689 KTG 56093 b
HB3220 - 21 - LRB103 29689 KTG 56093 b
1 (6) For general acute care hospitals an amount equal
2 to $290 multiplied by the hospital's category of service
3 29 case mix index for the determination quarter multiplied
4 by the hospital's total number of category of service 29
5 paid EAPGs for the determination quarter.
6 (7) For high Medicaid hospitals an amount equal to
7 $1,800 multiplied by the hospital's category of service 20
8 case mix index for the determination quarter multiplied by
9 the hospital's total number of inpatient admissions for
10 category of service 20 for the determination quarter.
11 (8) For high Medicaid hospitals an amount equal to
12 $160 multiplied by the hospital's category of service 21
13 case mix index for the determination quarter multiplied by
14 the hospital's total number of inpatient admissions for
15 category of service 21 for the determination quarter.
16 (9) For high Medicaid hospitals an amount equal to $80
17 multiplied by the hospital's category of service 22 case
18 mix index for the determination quarter multiplied by the
19 hospital's total number of inpatient admissions for
20 category of service 22 for the determination quarter.
21 (10) For high Medicaid hospitals an amount equal to
22 $400 multiplied by the hospital's category of service 24
23 case mix index for the determination quarter multiplied by
24 the hospital's total number of category of service 24 paid
25 EAPG outpatient claims for the determination quarter.
26 (11) For high Medicaid hospitals an amount equal to
HB3220 - 21 - LRB103 29689 KTG 56093 b
HB3220- 22 -LRB103 29689 KTG 56093 b HB3220 - 22 - LRB103 29689 KTG 56093 b
HB3220 - 22 - LRB103 29689 KTG 56093 b
1 $240 multiplied by the hospital's category of service 27
2 and 28 case mix index for the determination quarter
3 multiplied by the hospital's total number of category of
4 service 27 and 28 paid EAPGs for the determination
5 quarter.
6 (12) For high Medicaid hospitals an amount equal to
7 $290 multiplied by the hospital's category of service 29
8 case mix index for the determination quarter multiplied by
9 the hospital's total number of category of service 29 paid
10 EAPGs for the determination quarter.
11 (13) For long term acute care hospitals the amount of
12 $495 multiplied by the hospital's total number of
13 inpatient days for the determination quarter.
14 (14) For psychiatric hospitals the amount of $210
15 multiplied by the hospital's total number of inpatient
16 days for category of service 21 for the determination
17 quarter.
18 (15) For psychiatric hospitals the amount of $250
19 multiplied by the hospital's total number of outpatient
20 claims for category of service 27 and 28 for the
21 determination quarter.
22 (16) For rehabilitation hospitals the amount of $410
23 multiplied by the hospital's total number of inpatient
24 days for category of service 22 for the determination
25 quarter.
26 (17) For rehabilitation hospitals the amount of $100
HB3220 - 22 - LRB103 29689 KTG 56093 b
HB3220- 23 -LRB103 29689 KTG 56093 b HB3220 - 23 - LRB103 29689 KTG 56093 b
HB3220 - 23 - LRB103 29689 KTG 56093 b
1 multiplied by the hospital's total number of outpatient
2 claims for category of service 29 for the determination
3 quarter.
4 (18) Effective for the Payout Quarter beginning
5 January 1, 2023, for the directed payments to hospitals
6 required under this subsection, the Department shall
7 establish the amounts that shall be used to calculate such
8 directed payments using the methodologies specified in
9 this paragraph. The Department shall use a single, uniform
10 rate, adjusted for acuity as specified in paragraphs (1)
11 through (12), for all categories of inpatient services
12 provided by each class of hospitals and a single uniform
13 rate, adjusted for acuity as specified in paragraphs (1)
14 through (12), for all categories of outpatient services
15 provided by each class of hospitals. The Department shall
16 establish such amounts so that the total amount of
17 payments to each hospital under this Section in calendar
18 year 2023 is projected to be substantially similar to the
19 total amount of such payments received by the hospital
20 under this Section in calendar year 2021, adjusted for
21 increased funding provided for fixed pool directed
22 payments under subsection (g) in calendar year 2022,
23 assuming that the volume and acuity of claims are held
24 constant. The Department shall publish the directed
25 payment amounts to be established under this subsection on
26 its website by November 15, 2022.
HB3220 - 23 - LRB103 29689 KTG 56093 b
HB3220- 24 -LRB103 29689 KTG 56093 b HB3220 - 24 - LRB103 29689 KTG 56093 b
HB3220 - 24 - LRB103 29689 KTG 56093 b
1 (19) Each hospital shall be paid 1/3 of their
2 quarterly inpatient and outpatient directed payment in
3 each of the 3 months of the Payout Quarter, in accordance
4 with directions provided to each MCO by the Department.
5 20 Each MCO shall pay each hospital the Monthly
6 Directed Payment amount as identified by the Department on
7 its quarterly determination report.
8 Notwithstanding any other provision of this subsection, if
9 the Department determines that the actual total hospital
10 utilization data that is used to calculate the fixed rate
11 directed payments is substantially different than anticipated
12 when the rates in this subsection were initially determined
13 for unforeseeable circumstances (such as the COVID-19 pandemic
14 or some other public health emergency), the Department may
15 adjust the rates specified in this subsection so that the
16 total directed payments approximate the total spending amount
17 anticipated when the rates were initially established.
18 Definitions. As used in this subsection:
19 (A) "Payout Quarter" means each calendar quarter,
20 beginning July 1, 2020.
21 (B) "Determination Quarter" means each calendar
22 quarter which ends 3 months prior to the first day of
23 each Payout Quarter.
24 (C) "Case mix index" means a hospital specific
25 calculation. For inpatient claims the case mix index
26 is calculated each quarter by summing the relative
HB3220 - 24 - LRB103 29689 KTG 56093 b
HB3220- 25 -LRB103 29689 KTG 56093 b HB3220 - 25 - LRB103 29689 KTG 56093 b
HB3220 - 25 - LRB103 29689 KTG 56093 b
1 weight of all inpatient Diagnosis-Related Group (DRG)
2 claims for a category of service in the applicable
3 Determination Quarter and dividing the sum by the
4 number of sum total of all inpatient DRG admissions
5 for the category of service for the associated claims.
6 The case mix index for outpatient claims is calculated
7 each quarter by summing the relative weight of all
8 paid EAPGs in the applicable Determination Quarter and
9 dividing the sum by the sum total of paid EAPGs for the
10 associated claims.
11 (i) Beginning January 1, 2021, the rates for directed
12 payments shall be recalculated in order to spend the
13 additional funds for directed payments that result from
14 reduction in the amount of pass-through payments allowed under
15 federal regulations. The additional funds for directed
16 payments shall be allocated proportionally to each class of
17 hospitals based on that class' proportion of services.
18 (1) Beginning January 1, 2024, the fixed pool directed
19 payment amounts and the associated annual initial rates
20 referenced in paragraph (6) of subsection (f) for each
21 hospital class shall be uniformly increased by a ratio of
22 not less than, the ratio of the total pass-through
23 reduction amount pursuant to paragraph (4) of subsection
24 (j), for the hospitals comprising the hospital fixed pool
25 directed payment class for the next calendar year, to the
26 total inpatient and outpatient directed payments for the
HB3220 - 25 - LRB103 29689 KTG 56093 b
HB3220- 26 -LRB103 29689 KTG 56093 b HB3220 - 26 - LRB103 29689 KTG 56093 b
HB3220 - 26 - LRB103 29689 KTG 56093 b
1 hospitals comprising the hospital fixed pool directed
2 payment class paid during the preceding calendar year.
3 (2) Beginning January 1, 2024, the fixed rates for the
4 directed payments referenced in paragraph (18) of
5 subsection (h) for each hospital class shall be uniformly
6 increased by a ratio of not less than, the ratio of the
7 total pass-through reduction amount pursuant to paragraph
8 (4) of subsection (j), for the hospitals comprising the
9 hospital directed payment class for the next calendar
10 year, to the total inpatient and outpatient directed
11 payments for the hospitals comprising the hospital fixed
12 rate directed payment class paid during the preceding
13 calendar year.
14 (j) Pass-through payments.
15 (1) For the period July 1, 2020 through December 31,
16 2020, the Department shall assign quarterly pass-through
17 payments to each class of hospitals equal to one-fourth of
18 the following annual allocations:
19 (A) $390,487,095 to safety-net hospitals.
20 (B) $62,553,886 to critical access hospitals.
21 (C) $345,021,438 to high Medicaid hospitals.
22 (D) $551,429,071 to general acute care hospitals.
23 (E) $27,283,870 to long term acute care hospitals.
24 (F) $40,825,444 to freestanding psychiatric
25 hospitals.
26 (G) $9,652,108 to freestanding rehabilitation
HB3220 - 26 - LRB103 29689 KTG 56093 b
HB3220- 27 -LRB103 29689 KTG 56093 b HB3220 - 27 - LRB103 29689 KTG 56093 b
HB3220 - 27 - LRB103 29689 KTG 56093 b
1 hospitals.
2 (2) For the period of July 1, 2020 through December
3 31, 2020, the pass-through payments shall at a minimum
4 ensure hospitals receive a total amount of monthly
5 payments under this Section as received in calendar year
6 2019 in accordance with this Article and paragraph (1) of
7 subsection (d-5) of Section 14-12, exclusive of amounts
8 received through payments referenced in subsection (b).
9 (3) For the calendar year beginning January 1, 2023,
10 the Department shall establish the annual pass-through
11 allocation to each class of hospitals and the pass-through
12 payments to each hospital so that the total amount of
13 payments to each hospital under this Section in calendar
14 year 2023 is projected to be substantially similar to the
15 total amount of such payments received by the hospital
16 under this Section in calendar year 2021, adjusted for
17 increased funding provided for fixed pool directed
18 payments under subsection (g) in calendar year 2022,
19 assuming that the volume and acuity of claims are held
20 constant. The Department shall publish the pass-through
21 allocation to each class and the pass-through payments to
22 each hospital to be established under this subsection on
23 its website by November 15, 2022.
24 (4) For the calendar years beginning January 1, 2021,
25 January 1, 2022, and January 1, 2024, and each calendar
26 year thereafter, each hospital's pass-through payment
HB3220 - 27 - LRB103 29689 KTG 56093 b
HB3220- 28 -LRB103 29689 KTG 56093 b HB3220 - 28 - LRB103 29689 KTG 56093 b
HB3220 - 28 - LRB103 29689 KTG 56093 b
1 amount shall be reduced proportionally to the reduction of
2 all pass-through payments required by federal regulations.
3 (k) At least 30 days prior to each calendar year, the
4 Department shall notify each hospital of changes to the
5 payment methodologies in this Section, including, but not
6 limited to, changes in the fixed rate directed payment rates,
7 the aggregate pass-through payment amount for all hospitals,
8 and the hospital's pass-through payment amount for the
9 upcoming calendar year.
10 (l) Notwithstanding any other provisions of this Section,
11 the Department may adopt rules to change the methodology for
12 directed and pass-through payments as set forth in this
13 Section, but only to the extent necessary to obtain federal
14 approval of a necessary State Plan amendment or Directed
15 Payment Preprint or to otherwise conform to federal law or
16 federal regulation.
17 (m) As used in this subsection, "managed care
18 organization" or "MCO" means an entity which contracts with
19 the Department to provide services where payment for medical
20 services is made on a capitated basis, excluding contracted
21 entities for dual eligible or Department of Children and
22 Family Services youth populations.
23 (n) In order to address the escalating infant mortality
24 rates among minority communities in Illinois, the State shall,
25 subject to appropriation, create a pool of funding of at least
26 $55,000,000 $50,000,000 annually to be disbursed among
HB3220 - 28 - LRB103 29689 KTG 56093 b
HB3220- 29 -LRB103 29689 KTG 56093 b HB3220 - 29 - LRB103 29689 KTG 56093 b
HB3220 - 29 - LRB103 29689 KTG 56093 b
1 safety-net hospitals that maintain perinatal designation from
2 the Department of Public Health. The funding shall be used to
3 preserve or enhance OB/GYN services or other specialty
4 services at the receiving hospital, with the distribution of
5 funding to be established by rule and with consideration to
6 perinatal hospitals with safe birthing levels and quality
7 metrics for healthy mothers and babies. In addition,
8 $5,000,000 of this amount shall be disbursed to non-safety net
9 hospitals that serve at least 44% Medicaid patients and handle
10 a minimum of 1,000 births per year and are designated by the
11 Department of Public Health as perinatal level III hospitals
12 to maintain access to such services for Medicaid eligible
13 mothers and babies.
14 (o) In order to address the growing challenges of
15 providing stable access to healthcare in rural Illinois,
16 including perinatal services, behavioral healthcare including
17 substance use disorder services (SUDs) and other specialty
18 services, and to expand access to telehealth services among
19 rural communities in Illinois, the Department of Healthcare
20 and Family Services, subject to appropriation, shall
21 administer a program to provide at least $10,000,000 in
22 financial support annually to critical access hospitals for
23 delivery of perinatal and OB/GYN services, behavioral
24 healthcare including SUDS, other specialty services and
25 telehealth services. The funding shall be used to preserve or
26 enhance perinatal and OB/GYN services, behavioral healthcare
HB3220 - 29 - LRB103 29689 KTG 56093 b
HB3220- 30 -LRB103 29689 KTG 56093 b HB3220 - 30 - LRB103 29689 KTG 56093 b
HB3220 - 30 - LRB103 29689 KTG 56093 b
1 including SUDS, other specialty services, as well as the
2 explanation of telehealth services by the receiving hospital,
3 with the distribution of funding to be established by rule.
4 (p) For calendar year 2023, the final amounts, rates, and
5 payments under subsections (c), (d-2), (g), (h), and (j) shall
6 be established by the Department, so that the sum of the total
7 estimated annual payments under subsections (c), (d-2), (g),
8 (h), and (j) for each hospital class for calendar year 2023, is
9 no less than:
10 (1) $858,260,000 to safety-net hospitals.
11 (2) $86,200,000 to critical access hospitals.
12 (3) $1,765,000,000 to high Medicaid hospitals.
13 (4) $673,860,000 to general acute care hospitals.
14 (5) $48,330,000 to long term acute care hospitals.
15 (6) $89,110,000 to freestanding psychiatric hospitals.
16 (7) $24,300,000 to freestanding rehabilitation
17 hospitals.
18 (8) $32,570,000 to public hospitals.
19 (q) Hospital Pandemic Recovery Stabilization Payments. The
20 Department shall disburse a pool of $460,000,000 in stability
21 payments to hospitals prior to April 1, 2023. The allocation
22 of the pool shall be based on the hospital directed payment
23 classes and directed payments issued, during Calendar Year
24 2022 with added consideration to safety net hospitals, as
25 defined in subdivision (f)(1)(B) of this Section, and critical
26 access hospitals.
HB3220 - 30 - LRB103 29689 KTG 56093 b
HB3220- 31 -LRB103 29689 KTG 56093 b HB3220 - 31 - LRB103 29689 KTG 56093 b
HB3220 - 31 - LRB103 29689 KTG 56093 b
1 (Source: P.A. 101-650, eff. 7-7-20; 102-4, eff. 4-27-21;
2 102-16, eff. 6-17-21; 102-886, eff. 5-17-22; 102-1115, eff.
3 1-9-23.)
HB3220 - 31 - LRB103 29689 KTG 56093 b