Illinois 2023-2024 Regular Session

Illinois House Bill HB4741 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 HB4741 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. In a provision requiring the Department of Healthcare and Family Services to create a pool of funding of at least $50,000,000 annually to be disbursed among safety-net hospitals that maintain perinatal designation from the Department of Public Health, provides that no safety-net hospital eligible for funds shall receive less than $5,000,000 annually. LRB103 37771 KTG 67900 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4741 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. In a provision requiring the Department of Healthcare and Family Services to create a pool of funding of at least $50,000,000 annually to be disbursed among safety-net hospitals that maintain perinatal designation from the Department of Public Health, provides that no safety-net hospital eligible for funds shall receive less than $5,000,000 annually. LRB103 37771 KTG 67900 b LRB103 37771 KTG 67900 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB4741 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. In a provision requiring the Department of Healthcare and Family Services to create a pool of funding of at least $50,000,000 annually to be disbursed among safety-net hospitals that maintain perinatal designation from the Department of Public Health, provides that no safety-net hospital eligible for funds shall receive less than $5,000,000 annually.
6	6	LRB103 37771 KTG 67900 b LRB103 37771 KTG 67900 b
7	7	LRB103 37771 KTG 67900 b
8	8	A BILL FOR
9	9	HB4741LRB103 37771 KTG 67900 b HB4741 LRB103 37771 KTG 67900 b
10	10	HB4741 LRB103 37771 KTG 67900 b
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 HB4741 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. In a provision requiring the Department of Healthcare and Family Services to create a pool of funding of at least $50,000,000 annually to be disbursed among safety-net hospitals that maintain perinatal designation from the Department of Public Health, provides that no safety-net hospital eligible for funds shall receive less than $5,000,000 annually.
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42	42	LRB103 37771 KTG 67900 b
43	43	A BILL FOR
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49	49	305 ILCS 5/5A-12.7
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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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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	HB4741 - 14 - LRB103 37771 KTG 67900 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 (3) Beginning January 1, 2024, the Department may reassign
516	516	17 hospitals or entire hospital classes as defined above, if
517	517	18 federal limits on the payments to the class to which the
518	518	19 hospitals are assigned based on the criteria in this
519	519	20 subsection prevent the Department from making payments to the
520	520	21 class that would otherwise be due under this Section. The
521	521	22 Department shall publish the criteria and composition of each
522	522	23 new class based on the reassignments, and the projected impact
523	523	24 on payments to each hospital under the new classes on its
524	524	25 website by November 15 of the year before the year in which the
525	525	26 class changes become effective.
526	526
527	527
528	528
529	529
530	530
531	531	HB4741 - 14 - LRB103 37771 KTG 67900 b
532	532
533	533
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535	535	HB4741 - 15 - LRB103 37771 KTG 67900 b
536	536	1 (g) Fixed pool directed payments. Beginning July 1, 2020,
537	537	2 the Department shall issue payments to MCOs which shall be
538	538	3 used to issue directed payments to qualified Illinois
539	539	4 safety-net hospitals and critical access hospitals on a
540	540	5 monthly basis in accordance with this subsection. Prior to the
541	541	6 beginning of each Payout Quarter beginning July 1, 2020, the
542	542	7 Department shall use encounter claims data from the
543	543	8 Determination Quarter, accepted by the Department's Medicaid
544	544	9 Management Information System for inpatient and outpatient
545	545	10 services rendered by safety-net hospitals and critical access
546	546	11 hospitals to determine a quarterly uniform per unit add-on for
547	547	12 each hospital class.
548	548	13 (1) Inpatient per unit add-on. A quarterly uniform per
549	549	14 diem add-on shall be derived by dividing the quarterly
550	550	15 Inpatient Directed Payments Pool amount allocated to the
551	551	16 applicable hospital class by the total inpatient days
552	552	17 contained on all encounter claims received during the
553	553	18 Determination Quarter, for all hospitals in the class.
554	554	19 (A) Each hospital in the class shall have a
555	555	20 quarterly inpatient directed payment calculated that
556	556	21 is equal to the product of the number of inpatient days
557	557	22 attributable to the hospital used in the calculation
558	558	23 of the quarterly uniform class per diem add-on,
559	559	24 multiplied by the calculated applicable quarterly
560	560	25 uniform class per diem add-on of the hospital class.
561	561	26 (B) Each hospital shall be paid 1/3 of its
562	562
563	563
564	564
565	565
566	566
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568	568
569	569
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571	571	HB4741 - 16 - LRB103 37771 KTG 67900 b
572	572	1 quarterly inpatient directed payment in each of the 3
573	573	2 months of the Payout Quarter, in accordance with
574	574	3 directions provided to each MCO by the Department.
575	575	4 (2) Outpatient per unit add-on. A quarterly uniform
576	576	5 per claim add-on shall be derived by dividing the
577	577	6 quarterly Outpatient Directed Payments Pool amount
578	578	7 allocated to the applicable hospital class by the total
579	579	8 outpatient encounter claims received during the
580	580	9 Determination Quarter, for all hospitals in the class.
581	581	10 (A) Each hospital in the class shall have a
582	582	11 quarterly outpatient directed payment calculated that
583	583	12 is equal to the product of the number of outpatient
584	584	13 encounter claims attributable to the hospital used in
585	585	14 the calculation of the quarterly uniform class per
586	586	15 claim add-on, multiplied by the calculated applicable
587	587	16 quarterly uniform class per claim add-on of the
588	588	17 hospital class.
589	589	18 (B) Each hospital shall be paid 1/3 of its
590	590	19 quarterly outpatient directed payment in each of the 3
591	591	20 months of the Payout Quarter, in accordance with
592	592	21 directions provided to each MCO by the Department.
593	593	22 (3) Each MCO shall pay each hospital the Monthly
594	594	23 Directed Payment as identified by the Department on its
595	595	24 quarterly determination report.
596	596	25 (4) Definitions. As used in this subsection:
597	597	26 (A) "Payout Quarter" means each 3 month calendar
598	598
599	599
600	600
601	601
602	602
603	603	HB4741 - 16 - LRB103 37771 KTG 67900 b
604	604
605	605
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607	607	HB4741 - 17 - LRB103 37771 KTG 67900 b
608	608	1 quarter, beginning July 1, 2020.
609	609	2 (B) "Determination Quarter" means each 3 month
610	610	3 calendar quarter, which ends 3 months prior to the
611	611	4 first day of each Payout Quarter.
612	612	5 (5) For the period July 1, 2020 through December 2020,
613	613	6 the following amounts shall be allocated to the following
614	614	7 hospital class directed payment pools for the quarterly
615	615	8 development of a uniform per unit add-on:
616	616	9 (A) $2,894,500 for hospital inpatient services for
617	617	10 critical access hospitals.
618	618	11 (B) $4,294,374 for hospital outpatient services
619	619	12 for critical access hospitals.
620	620	13 (C) $29,109,330 for hospital inpatient services
621	621	14 for safety-net hospitals.
622	622	15 (D) $35,041,218 for hospital outpatient services
623	623	16 for safety-net hospitals.
624	624	17 (6) For the period January 1, 2023 through December
625	625	18 31, 2023, the Department shall establish the amounts that
626	626	19 shall be allocated to the hospital class directed payment
627	627	20 fixed pools identified in this paragraph for the quarterly
628	628	21 development of a uniform per unit add-on. The Department
629	629	22 shall establish such amounts so that the total amount of
630	630	23 payments to each hospital under this Section in calendar
631	631	24 year 2023 is projected to be substantially similar to the
632	632	25 total amount of such payments received by the hospital
633	633	26 under this Section in calendar year 2021, adjusted for
634	634
635	635
636	636
637	637
638	638
639	639	HB4741 - 17 - LRB103 37771 KTG 67900 b
640	640
641	641
642	642	HB4741- 18 -LRB103 37771 KTG 67900 b HB4741 - 18 - LRB103 37771 KTG 67900 b
643	643	HB4741 - 18 - LRB103 37771 KTG 67900 b
644	644	1 increased funding provided for fixed pool directed
645	645	2 payments under subsection (g) in calendar year 2022,
646	646	3 assuming that the volume and acuity of claims are held
647	647	4 constant. The Department shall publish the directed
648	648	5 payment fixed pool amounts to be established under this
649	649	6 paragraph on its website by November 15, 2022.
650	650	7 (A) Hospital inpatient services for critical
651	651	8 access hospitals.
652	652	9 (B) Hospital outpatient services for critical
653	653	10 access hospitals.
654	654	11 (C) Hospital inpatient services for public
655	655	12 hospitals.
656	656	13 (D) Hospital outpatient services for public
657	657	14 hospitals.
658	658	15 (E) Hospital inpatient services for safety-net
659	659	16 hospitals.
660	660	17 (F) Hospital outpatient services for safety-net
661	661	18 hospitals.
662	662	19 (7) Semi-annual rate maintenance review. The
663	663	20 Department shall ensure that hospitals assigned to the
664	664	21 fixed pools in paragraph (6) are paid no less than 95% of
665	665	22 the annual initial rate for each 6-month period of each
666	666	23 annual payout period. For each calendar year, the
667	667	24 Department shall calculate the annual initial rate per day
668	668	25 and per visit for each fixed pool hospital class listed in
669	669	26 paragraph (6), by dividing the total of all applicable
670	670
671	671
672	672
673	673
674	674
675	675	HB4741 - 18 - LRB103 37771 KTG 67900 b
676	676
677	677
678	678	HB4741- 19 -LRB103 37771 KTG 67900 b HB4741 - 19 - LRB103 37771 KTG 67900 b
679	679	HB4741 - 19 - LRB103 37771 KTG 67900 b
680	680	1 inpatient or outpatient directed payments issued in the
681	681	2 preceding calendar year to the hospitals in each fixed
682	682	3 pool class for the calendar year, plus any increase
683	683	4 resulting from the annual adjustments described in
684	684	5 subsection (i), by the actual applicable total service
685	685	6 units for the preceding calendar year which were the basis
686	686	7 of the total applicable inpatient or outpatient directed
687	687	8 payments issued to the hospitals in each fixed pool class
688	688	9 in the calendar year, except that for calendar year 2023,
689	689	10 the service units from calendar year 2021 shall be used.
690	690	11 (A) The Department shall calculate the effective
691	691	12 rate, per day and per visit, for the payout periods of
692	692	13 January to June and July to December of each year, for
693	693	14 each fixed pool listed in paragraph (6), by dividing
694	694	15 50% of the annual pool by the total applicable
695	695	16 reported service units for the 2 applicable
696	696	17 determination quarters.
697	697	18 (B) If the effective rate calculated in
698	698	19 subparagraph (A) is less than 95% of the annual
699	699	20 initial rate assigned to the class for each pool under
700	700	21 paragraph (6), the Department shall adjust the payment
701	701	22 for each hospital to a level equal to no less than 95%
702	702	23 of the annual initial rate, by issuing a retroactive
703	703	24 adjustment payment for the 6-month period under review
704	704	25 as identified in subparagraph (A).
705	705	26 (h) Fixed rate directed payments. Effective July 1, 2020,
706	706
707	707
708	708
709	709
710	710
711	711	HB4741 - 19 - LRB103 37771 KTG 67900 b
712	712
713	713
714	714	HB4741- 20 -LRB103 37771 KTG 67900 b HB4741 - 20 - LRB103 37771 KTG 67900 b
715	715	HB4741 - 20 - LRB103 37771 KTG 67900 b
716	716	1 the Department shall issue payments to MCOs which shall be
717	717	2 used to issue directed payments to Illinois hospitals not
718	718	3 identified in paragraph (g) on a monthly basis. Prior to the
719	719	4 beginning of each Payout Quarter beginning July 1, 2020, the
720	720	5 Department shall use encounter claims data from the
721	721	6 Determination Quarter, accepted by the Department's Medicaid
722	722	7 Management Information System for inpatient and outpatient
723	723	8 services rendered by hospitals in each hospital class
724	724	9 identified in paragraph (f) and not identified in paragraph
725	725	10 (g). For the period July 1, 2020 through December 2020, the
726	726	11 Department shall direct MCOs to make payments as follows:
727	727	12 (1) For general acute care hospitals an amount equal
728	728	13 to $1,750 multiplied by the hospital's category of service
729	729	14 20 case mix index for the determination quarter multiplied
730	730	15 by the hospital's total number of inpatient admissions for
731	731	16 category of service 20 for the determination quarter.
732	732	17 (2) For general acute care hospitals an amount equal
733	733	18 to $160 multiplied by the hospital's category of service
734	734	19 21 case mix index for the determination quarter multiplied
735	735	20 by the hospital's total number of inpatient admissions for
736	736	21 category of service 21 for the determination quarter.
737	737	22 (3) For general acute care hospitals an amount equal
738	738	23 to $80 multiplied by the hospital's category of service 22
739	739	24 case mix index for the determination quarter multiplied by
740	740	25 the hospital's total number of inpatient admissions for
741	741	26 category of service 22 for the determination quarter.
742	742
743	743
744	744
745	745
746	746
747	747	HB4741 - 20 - LRB103 37771 KTG 67900 b
748	748
749	749
750	750	HB4741- 21 -LRB103 37771 KTG 67900 b HB4741 - 21 - LRB103 37771 KTG 67900 b
751	751	HB4741 - 21 - LRB103 37771 KTG 67900 b
752	752	1 (4) For general acute care hospitals an amount equal
753	753	2 to $375 multiplied by the hospital's category of service
754	754	3 24 case mix index for the determination quarter multiplied
755	755	4 by the hospital's total number of category of service 24
756	756	5 paid EAPG (EAPGs) for the determination quarter.
757	757	6 (5) For general acute care hospitals an amount equal
758	758	7 to $240 multiplied by the hospital's category of service
759	759	8 27 and 28 case mix index for the determination quarter
760	760	9 multiplied by the hospital's total number of category of
761	761	10 service 27 and 28 paid EAPGs for the determination
762	762	11 quarter.
763	763	12 (6) For general acute care hospitals an amount equal
764	764	13 to $290 multiplied by the hospital's category of service
765	765	14 29 case mix index for the determination quarter multiplied
766	766	15 by the hospital's total number of category of service 29
767	767	16 paid EAPGs for the determination quarter.
768	768	17 (7) For high Medicaid hospitals an amount equal to
769	769	18 $1,800 multiplied by the hospital's category of service 20
770	770	19 case mix index for the determination quarter multiplied by
771	771	20 the hospital's total number of inpatient admissions for
772	772	21 category of service 20 for the determination quarter.
773	773	22 (8) For high Medicaid hospitals an amount equal to
774	774	23 $160 multiplied by the hospital's category of service 21
775	775	24 case mix index for the determination quarter multiplied by
776	776	25 the hospital's total number of inpatient admissions for
777	777	26 category of service 21 for the determination quarter.
778	778
779	779
780	780
781	781
782	782
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784	784
785	785
786	786	HB4741- 22 -LRB103 37771 KTG 67900 b HB4741 - 22 - LRB103 37771 KTG 67900 b
787	787	HB4741 - 22 - LRB103 37771 KTG 67900 b
788	788	1 (9) For high Medicaid hospitals an amount equal to $80
789	789	2 multiplied by the hospital's category of service 22 case
790	790	3 mix index for the determination quarter multiplied by the
791	791	4 hospital's total number of inpatient admissions for
792	792	5 category of service 22 for the determination quarter.
793	793	6 (10) For high Medicaid hospitals an amount equal to
794	794	7 $400 multiplied by the hospital's category of service 24
795	795	8 case mix index for the determination quarter multiplied by
796	796	9 the hospital's total number of category of service 24 paid
797	797	10 EAPG outpatient claims for the determination quarter.
798	798	11 (11) For high Medicaid hospitals an amount equal to
799	799	12 $240 multiplied by the hospital's category of service 27
800	800	13 and 28 case mix index for the determination quarter
801	801	14 multiplied by the hospital's total number of category of
802	802	15 service 27 and 28 paid EAPGs for the determination
803	803	16 quarter.
804	804	17 (12) For high Medicaid hospitals an amount equal to
805	805	18 $290 multiplied by the hospital's category of service 29
806	806	19 case mix index for the determination quarter multiplied by
807	807	20 the hospital's total number of category of service 29 paid
808	808	21 EAPGs for the determination quarter.
809	809	22 (13) For long term acute care hospitals the amount of
810	810	23 $495 multiplied by the hospital's total number of
811	811	24 inpatient days for the determination quarter.
812	812	25 (14) For psychiatric hospitals the amount of $210
813	813	26 multiplied by the hospital's total number of inpatient
814	814
815	815
816	816
817	817
818	818
819	819	HB4741 - 22 - LRB103 37771 KTG 67900 b
820	820
821	821
822	822	HB4741- 23 -LRB103 37771 KTG 67900 b HB4741 - 23 - LRB103 37771 KTG 67900 b
823	823	HB4741 - 23 - LRB103 37771 KTG 67900 b
824	824	1 days for category of service 21 for the determination
825	825	2 quarter.
826	826	3 (15) For psychiatric hospitals the amount of $250
827	827	4 multiplied by the hospital's total number of outpatient
828	828	5 claims for category of service 27 and 28 for the
829	829	6 determination quarter.
830	830	7 (16) For rehabilitation hospitals the amount of $410
831	831	8 multiplied by the hospital's total number of inpatient
832	832	9 days for category of service 22 for the determination
833	833	10 quarter.
834	834	11 (17) For rehabilitation hospitals the amount of $100
835	835	12 multiplied by the hospital's total number of outpatient
836	836	13 claims for category of service 29 for the determination
837	837	14 quarter.
838	838	15 (18) Effective for the Payout Quarter beginning
839	839	16 January 1, 2023, for the directed payments to hospitals
840	840	17 required under this subsection, the Department shall
841	841	18 establish the amounts that shall be used to calculate such
842	842	19 directed payments using the methodologies specified in
843	843	20 this paragraph. The Department shall use a single, uniform
844	844	21 rate, adjusted for acuity as specified in paragraphs (1)
845	845	22 through (12), for all categories of inpatient services
846	846	23 provided by each class of hospitals and a single uniform
847	847	24 rate, adjusted for acuity as specified in paragraphs (1)
848	848	25 through (12), for all categories of outpatient services
849	849	26 provided by each class of hospitals. The Department shall
850	850
851	851
852	852
853	853
854	854
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856	856
857	857
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859	859	HB4741 - 24 - LRB103 37771 KTG 67900 b
860	860	1 establish such amounts so that the total amount of
861	861	2 payments to each hospital under this Section in calendar
862	862	3 year 2023 is projected to be substantially similar to the
863	863	4 total amount of such payments received by the hospital
864	864	5 under this Section in calendar year 2021, adjusted for
865	865	6 increased funding provided for fixed pool directed
866	866	7 payments under subsection (g) in calendar year 2022,
867	867	8 assuming that the volume and acuity of claims are held
868	868	9 constant. The Department shall publish the directed
869	869	10 payment amounts to be established under this subsection on
870	870	11 its website by November 15, 2022.
871	871	12 (19) Each hospital shall be paid 1/3 of their
872	872	13 quarterly inpatient and outpatient directed payment in
873	873	14 each of the 3 months of the Payout Quarter, in accordance
874	874	15 with directions provided to each MCO by the Department.
875	875	16 (20) Each MCO shall pay each hospital the Monthly
876	876	17 Directed Payment amount as identified by the Department on
877	877	18 its quarterly determination report.
878	878	19 Notwithstanding any other provision of this subsection, if
879	879	20 the Department determines that the actual total hospital
880	880	21 utilization data that is used to calculate the fixed rate
881	881	22 directed payments is substantially different than anticipated
882	882	23 when the rates in this subsection were initially determined
883	883	24 for unforeseeable circumstances (such as the COVID-19 pandemic
884	884	25 or some other public health emergency), the Department may
885	885	26 adjust the rates specified in this subsection so that the
886	886
887	887
888	888
889	889
890	890
891	891	HB4741 - 24 - LRB103 37771 KTG 67900 b
892	892
893	893
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895	895	HB4741 - 25 - LRB103 37771 KTG 67900 b
896	896	1 total directed payments approximate the total spending amount
897	897	2 anticipated when the rates were initially established.
898	898	3 Definitions. As used in this subsection:
899	899	4 (A) "Payout Quarter" means each calendar quarter,
900	900	5 beginning July 1, 2020.
901	901	6 (B) "Determination Quarter" means each calendar
902	902	7 quarter which ends 3 months prior to the first day of
903	903	8 each Payout Quarter.
904	904	9 (C) "Case mix index" means a hospital specific
905	905	10 calculation. For inpatient claims the case mix index
906	906	11 is calculated each quarter by summing the relative
907	907	12 weight of all inpatient Diagnosis-Related Group (DRG)
908	908	13 claims for a category of service in the applicable
909	909	14 Determination Quarter and dividing the sum by the
910	910	15 number of sum total of all inpatient DRG admissions
911	911	16 for the category of service for the associated claims.
912	912	17 The case mix index for outpatient claims is calculated
913	913	18 each quarter by summing the relative weight of all
914	914	19 paid EAPGs in the applicable Determination Quarter and
915	915	20 dividing the sum by the sum total of paid EAPGs for the
916	916	21 associated claims.
917	917	22 (i) Beginning January 1, 2021, the rates for directed
918	918	23 payments shall be recalculated in order to spend the
919	919	24 additional funds for directed payments that result from
920	920	25 reduction in the amount of pass-through payments allowed under
921	921	26 federal regulations. The additional funds for directed
922	922
923	923
924	924
925	925
926	926
927	927	HB4741 - 25 - LRB103 37771 KTG 67900 b
928	928
929	929
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931	931	HB4741 - 26 - LRB103 37771 KTG 67900 b
932	932	1 payments shall be allocated proportionally to each class of
933	933	2 hospitals based on that class' proportion of services.
934	934	3 (1) Beginning January 1, 2024, the fixed pool directed
935	935	4 payment amounts and the associated annual initial rates
936	936	5 referenced in paragraph (6) of subsection (f) for each
937	937	6 hospital class shall be uniformly increased by a ratio of
938	938	7 not less than, the ratio of the total pass-through
939	939	8 reduction amount pursuant to paragraph (4) of subsection
940	940	9 (j), for the hospitals comprising the hospital fixed pool
941	941	10 directed payment class for the next calendar year, to the
942	942	11 total inpatient and outpatient directed payments for the
943	943	12 hospitals comprising the hospital fixed pool directed
944	944	13 payment class paid during the preceding calendar year.
945	945	14 (2) Beginning January 1, 2024, the fixed rates for the
946	946	15 directed payments referenced in paragraph (18) of
947	947	16 subsection (h) for each hospital class shall be uniformly
948	948	17 increased by a ratio of not less than, the ratio of the
949	949	18 total pass-through reduction amount pursuant to paragraph
950	950	19 (4) of subsection (j), for the hospitals comprising the
951	951	20 hospital directed payment class for the next calendar
952	952	21 year, to the total inpatient and outpatient directed
953	953	22 payments for the hospitals comprising the hospital fixed
954	954	23 rate directed payment class paid during the preceding
955	955	24 calendar year.
956	956	25 (j) Pass-through payments.
957	957	26 (1) For the period July 1, 2020 through December 31,
958	958
959	959
960	960
961	961
962	962
963	963	HB4741 - 26 - LRB103 37771 KTG 67900 b
964	964
965	965
966	966	HB4741- 27 -LRB103 37771 KTG 67900 b HB4741 - 27 - LRB103 37771 KTG 67900 b
967	967	HB4741 - 27 - LRB103 37771 KTG 67900 b
968	968	1 2020, the Department shall assign quarterly pass-through
969	969	2 payments to each class of hospitals equal to one-fourth of
970	970	3 the following annual allocations:
971	971	4 (A) $390,487,095 to safety-net hospitals.
972	972	5 (B) $62,553,886 to critical access hospitals.
973	973	6 (C) $345,021,438 to high Medicaid hospitals.
974	974	7 (D) $551,429,071 to general acute care hospitals.
975	975	8 (E) $27,283,870 to long term acute care hospitals.
976	976	9 (F) $40,825,444 to freestanding psychiatric
977	977	10 hospitals.
978	978	11 (G) $9,652,108 to freestanding rehabilitation
979	979	12 hospitals.
980	980	13 (2) For the period of July 1, 2020 through December
981	981	14 31, 2020, the pass-through payments shall at a minimum
982	982	15 ensure hospitals receive a total amount of monthly
983	983	16 payments under this Section as received in calendar year
984	984	17 2019 in accordance with this Article and paragraph (1) of
985	985	18 subsection (d-5) of Section 14-12, exclusive of amounts
986	986	19 received through payments referenced in subsection (b).
987	987	20 (3) For the calendar year beginning January 1, 2023,
988	988	21 the Department shall establish the annual pass-through
989	989	22 allocation to each class of hospitals and the pass-through
990	990	23 payments to each hospital so that the total amount of
991	991	24 payments to each hospital under this Section in calendar
992	992	25 year 2023 is projected to be substantially similar to the
993	993	26 total amount of such payments received by the hospital
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 under this Section in calendar year 2021, adjusted for
1005	1005	2 increased funding provided for fixed pool directed
1006	1006	3 payments under subsection (g) in calendar year 2022,
1007	1007	4 assuming that the volume and acuity of claims are held
1008	1008	5 constant. The Department shall publish the pass-through
1009	1009	6 allocation to each class and the pass-through payments to
1010	1010	7 each hospital to be established under this subsection on
1011	1011	8 its website by November 15, 2022.
1012	1012	9 (4) For the calendar years beginning January 1, 2021
1013	1013	10 and January 1, 2022, each hospital's pass-through payment
1014	1014	11 amount shall be reduced proportionally to the reduction of
1015	1015	12 all pass-through payments required by federal regulations.
1016	1016	13 Beginning January 1, 2024, the Department shall reduce
1017	1017	14 total pass-through payments by the minimum amount
1018	1018	15 necessary to comply with federal regulations. Pass-through
1019	1019	16 payments to safety-net hospitals, as defined in Section
1020	1020	17 5-5e.1 of this Code, shall not be reduced until all
1021	1021	18 pass-through payments to other hospitals have been
1022	1022	19 eliminated. All other hospitals shall have their
1023	1023	20 pass-through payments reduced proportionally.
1024	1024	21 (k) At least 30 days prior to each calendar year, the
1025	1025	22 Department shall notify each hospital of changes to the
1026	1026	23 payment methodologies in this Section, including, but not
1027	1027	24 limited to, changes in the fixed rate directed payment rates,
1028	1028	25 the aggregate pass-through payment amount for all hospitals,
1029	1029	26 and the hospital's pass-through payment amount for the
1030	1030
1031	1031
1032	1032
1033	1033
1034	1034
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1036	1036
1037	1037
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1040	1040	1 upcoming calendar year.
1041	1041	2 (l) Notwithstanding any other provisions of this Section,
1042	1042	3 the Department may adopt rules to change the methodology for
1043	1043	4 directed and pass-through payments as set forth in this
1044	1044	5 Section, but only to the extent necessary to obtain federal
1045	1045	6 approval of a necessary State Plan amendment or Directed
1046	1046	7 Payment Preprint or to otherwise conform to federal law or
1047	1047	8 federal regulation.
1048	1048	9 (m) As used in this subsection, "managed care
1049	1049	10 organization" or "MCO" means an entity which contracts with
1050	1050	11 the Department to provide services where payment for medical
1051	1051	12 services is made on a capitated basis, excluding contracted
1052	1052	13 entities for dual eligible or Department of Children and
1053	1053	14 Family Services youth populations.
1054	1054	15 (n) In order to address the escalating infant mortality
1055	1055	16 rates among minority communities in Illinois, the State shall,
1056	1056	17 subject to appropriation, create a pool of funding of at least
1057	1057	18 $50,000,000 annually to be disbursed among safety-net
1058	1058	19 hospitals that maintain perinatal designation from the
1059	1059	20 Department of Public Health. No safety-net hospital eligible
1060	1060	21 for funds under this subsection shall receive less than
1061	1061	22 $5,000,000 annually. The funding shall be used to preserve or
1062	1062	23 enhance OB/GYN services or other specialty services at the
1063	1063	24 receiving hospital, with the distribution of funding to be
1064	1064	25 established by rule and with consideration to perinatal
1065	1065	26 hospitals with safe birthing levels and quality metrics for
1066	1066
1067	1067
1068	1068
1069	1069
1070	1070
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1072	1072
1073	1073
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1075	1075	HB4741 - 30 - LRB103 37771 KTG 67900 b
1076	1076	1 healthy mothers and babies.
1077	1077	2 (o) In order to address the growing challenges of
1078	1078	3 providing stable access to healthcare in rural Illinois,
1079	1079	4 including perinatal services, behavioral healthcare including
1080	1080	5 substance use disorder services (SUDs) and other specialty
1081	1081	6 services, and to expand access to telehealth services among
1082	1082	7 rural communities in Illinois, the Department of Healthcare
1083	1083	8 and Family Services shall administer a program to provide at
1084	1084	9 least $10,000,000 in financial support annually to critical
1085	1085	10 access hospitals for delivery of perinatal and OB/GYN
1086	1086	11 services, behavioral healthcare including SUDS, other
1087	1087	12 specialty services and telehealth services. The funding shall
1088	1088	13 be used to preserve or enhance perinatal and OB/GYN services,
1089	1089	14 behavioral healthcare including SUDS, other specialty
1090	1090	15 services, as well as the explanation of telehealth services by
1091	1091	16 the receiving hospital, with the distribution of funding to be
1092	1092	17 established by rule.
1093	1093	18 (p) For calendar year 2023, the final amounts, rates, and
1094	1094	19 payments under subsections (c), (d-2), (g), (h), and (j) shall
1095	1095	20 be established by the Department, so that the sum of the total
1096	1096	21 estimated annual payments under subsections (c), (d-2), (g),
1097	1097	22 (h), and (j) for each hospital class for calendar year 2023, is
1098	1098	23 no less than:
1099	1099	24 (1) $858,260,000 to safety-net hospitals.
1100	1100	25 (2) $86,200,000 to critical access hospitals.
1101	1101	26 (3) $1,765,000,000 to high Medicaid hospitals.
1102	1102
1103	1103
1104	1104
1105	1105
1106	1106
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1108	1108
1109	1109
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1112	1112
1113	1113
1114	1114
1115	1115
1116	1116
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