305 ILCS 5/14-8
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article XIV - Hospital Services Trust Fund

 (from Ch. 23, par. 14-8)Sec. 14-8. Disbursements to Hospitals.(a) For inpatient hospital services rendered on and after September 1,  1991, the Illinois Department shall reimburse  hospitals for inpatient services at an inpatient payment rate calculated for  each hospital based upon the Medicare Prospective Payment System as set forth  in Sections 1886(b), (d), (g), and (h) of the federal Social Security Act, and  the regulations, policies, and procedures promulgated thereunder, except as  modified by this Section. Payment rates for inpatient hospital services  rendered on or after September 1, 1991 and on or before September 30, 1992  shall be calculated using the Medicare Prospective Payment rates in effect on  September 1, 1991.  Payment rates for inpatient hospital services rendered on  or after October 1, 1992 and on or before March 31, 1994 shall be calculated  using the Medicare Prospective Payment rates in effect on September 1, 1992.  Payment rates for inpatient hospital services rendered on or after April 1,  1994 shall be calculated using the Medicare Prospective Payment rates  (including the Medicare grouping methodology and weighting factors as adjusted  pursuant to paragraph (1) of this subsection) in  effect 90 days prior to the  date of admission.  For services rendered on or after July 1, 1995, the  reimbursement methodology implemented under this subsection shall not include  those costs referred to in Sections 1886(d)(5)(B) and 1886(h) of the Social  Security Act. The additional payment amounts required under Section  1886(d)(5)(F) of the Social Security Act, for hospitals serving a  disproportionate share of low-income or indigent patients, are not required  under this Section.  For hospital inpatient services rendered on or after July  1, 1995 and on or before June 30, 2014, the Illinois Department shall  reimburse hospitals using the relative weighting factors and the base payment  rates calculated for each hospital that were in effect on June 30, 1995, less  the portion of such rates attributed by the Illinois Department to the cost of  medical education.(1) The weighting factors established under Section     1886(d)(4) of the Social Security Act shall not be used in the reimbursement system established under this Section.  Rather, the Illinois Department shall establish by rule Medicaid weighting factors to be used in the reimbursement system established under this Section.(2) The Illinois Department shall define by rule     those hospitals or distinct parts of hospitals that shall be exempt from the reimbursement system established under this Section.  In defining such hospitals, the Illinois Department shall take into consideration those hospitals exempt from the Medicare Prospective Payment System as of September 1, 1991.  For hospitals defined as exempt under this subsection, the Illinois Department shall by rule establish a reimbursement system for payment of inpatient hospital services rendered on and after September 1, 1991.  For all hospitals that are children's hospitals as defined in Section 5-5.02 of this Code, the reimbursement methodology shall, through June 30, 1992, net of all applicable fees, at least equal each children's hospital 1990 ICARE payment rates, indexed to the current year by application of the DRI hospital cost index from 1989 to the year in which payments are made.  Excepting county providers as defined in Article XV of this Code, hospitals licensed under the University of Illinois Hospital Act, and facilities operated by the Department of Mental Health and Developmental Disabilities (or its successor, the Department of Human Services) for hospital inpatient services rendered on or after July 1, 1995 and on or before June 30, 2014, the Illinois Department shall reimburse children's hospitals, as defined in 89 Illinois Administrative Code Section 149.50(c)(3), at the rates in effect on June 30, 1995, and shall reimburse all other hospitals at the rates in effect on June 30, 1995, less the portion of such rates attributed by the Illinois Department to the cost of medical education. For inpatient hospital services provided on or after August 1, 1998, the Illinois Department may establish by rule a means of adjusting the rates of children's hospitals, as defined in 89 Illinois Administrative Code Section 149.50(c)(3), that did not meet that definition on June 30, 1995, in order for the inpatient hospital rates of such hospitals to take into account the average inpatient hospital rates of those children's hospitals that did meet the definition of children's hospitals on June 30, 1995.(3) (Blank).(4) Notwithstanding any other provision of this     Section, hospitals that on August 31, 1991, have a contract with the Illinois Department under Section 3-4 of the Illinois Health Finance Reform Act may elect to continue to be reimbursed at rates stated in such contracts for general and specialty care.(5) In addition to any payments made under this     subsection (a), the Illinois Department shall make the adjustment payments required by Section 5-5.02 of this Code; provided, that in the case of any hospital reimbursed under a per case methodology, the Illinois Department shall add an amount equal to the product of the hospital's average length of stay, less one day, multiplied by 20, for inpatient hospital services rendered on or after September 1, 1991 and on or before September 30, 1992.(b) (Blank).(b-5) Excepting county providers as defined in Article XV of this Code,  hospitals licensed under the University of Illinois Hospital Act, and  facilities operated by the Illinois Department of Mental Health and  Developmental Disabilities (or its successor, the Department of Human  Services), for outpatient services rendered on or after July 1, 1995  and before July 1, 1998 the Illinois Department shall reimburse  children's hospitals, as defined in the Illinois Administrative Code  Section 149.50(c)(3), at the rates in effect on June 30, 1995, less that  portion of such rates attributed by the Illinois Department to the outpatient  indigent volume adjustment and shall reimburse all other hospitals at the rates  in effect on June 30, 1995, less the portions of such rates attributed by the  Illinois Department to the cost of medical education and attributed by the  Illinois Department to the outpatient indigent volume adjustment.  For  outpatient services provided on or after July 1, 1998 and on or before June 30, 2014, reimbursement rates  shall be established by rule.(c) In addition to any other payments under this Code, the Illinois  Department shall develop a hospital disproportionate share reimbursement  methodology that, effective July 1, 1991, through September 30, 1992,  shall reimburse hospitals sufficiently to expend the fee monies described  in subsection (b) of Section 14-3 of this Code and the federal matching  funds received by the Illinois Department as a result of expenditures made  by the Illinois Department as required by this subsection (c) and Section  14-2 that are attributable to fee monies deposited in the Fund, less  amounts applied to adjustment payments under Section 5-5.02.(d) Critical Care Access Payments.(1) In addition to any other payments made under this     Code, the Illinois Department shall develop a reimbursement methodology that shall reimburse Critical Care Access Hospitals for the specialized services that qualify them as Critical Care Access Hospitals. No adjustment payments shall be made under this subsection on or after July 1, 1995.(2) "Critical Care Access Hospitals" includes, but is     not limited to, hospitals that meet at least one of the following criteria:(A) Hospitals located outside of a metropolitan         statistical area that are designated as Level II Perinatal Centers and that provide a disproportionate share of perinatal services to recipients; or(B) Hospitals that are designated as Level I         Trauma Centers (adult or pediatric) and certain Level II Trauma Centers as determined by the Illinois Department; or(C) Hospitals located outside of a metropolitan         statistical area and that provide a disproportionate share of obstetrical services to recipients.(e) Inpatient high volume adjustment.  For hospital inpatient services,  effective with rate periods beginning on or after October 1, 1993, in  addition to rates paid for inpatient services by the Illinois Department, the  Illinois Department shall make adjustment payments for inpatient services  furnished by Medicaid high volume hospitals.  The Illinois Department shall  establish by rule criteria for qualifying as a Medicaid high volume hospital  and shall establish by rule a reimbursement methodology for calculating these  adjustment payments to Medicaid high volume hospitals. No adjustment payment  shall be made under this subsection for services rendered on or after July 1,  1995.(f) The Illinois Department shall modify its current rules governing  adjustment payments for targeted access, critical care access, and  uncompensated care to classify those adjustment payments as not being payments  to disproportionate share hospitals under Title XIX of the federal Social  Security Act. Rules adopted under this subsection shall not be effective with  respect to services rendered on or after July 1, 1995.  The Illinois Department  has no obligation to adopt or implement any rules or make any payments under  this subsection for services rendered on or after July 1, 1995.(f-5) The State recognizes that adjustment payments to hospitals providing  certain services or incurring certain costs may be necessary to assure that  recipients of medical assistance have adequate access to necessary medical  services.  These adjustments include payments for teaching costs and  uncompensated care, trauma center payments, rehabilitation hospital payments,  perinatal center payments, obstetrical care payments, targeted access payments,  Medicaid high volume payments, and outpatient indigent volume payments.  On or  before April 1, 1995, the Illinois Department shall issue recommendations  regarding (i) reimbursement mechanisms or adjustment payments to reflect these  costs and services, including methods by which the payments may be calculated  and the method by which the payments may be financed, and (ii) reimbursement  mechanisms or adjustment payments to reflect costs and services of federally  qualified health centers with respect to recipients of medical assistance.(g) If one or more hospitals file suit in any court challenging any part of  this Article XIV, payments to hospitals under this Article XIV shall be made  only to the extent that sufficient monies are available in the Fund and only to  the extent that any monies in the Fund are not prohibited from disbursement  under any order of the court.(h) Payments under the disbursement methodology described in this Section  are subject to approval by the federal government in an appropriate State plan  amendment.(i) The Illinois Department may by rule establish criteria for and develop  methodologies for adjustment payments to hospitals participating under this  Article.(j) Hospital Residing Long Term Care Services. In addition to any other  payments made under this Code, the Illinois Department may by rule establish  criteria and develop methodologies for payments to hospitals for Hospital  Residing Long Term Care Services.(k) Critical Access Hospital outpatient payments.  In addition to any other payments authorized under this Code, the Illinois Department shall reimburse critical access hospitals, as designated by the Illinois Department of Public Health in accordance with 42 CFR 485, Subpart F, for outpatient services at an amount that is no less than the cost of providing such services, based on Medicare cost principles.  Payments under this subsection shall be subject to appropriation.(l) On and after July 1, 2012, the Department shall reduce any rate of reimbursement for services or other payments or alter any methodologies authorized by this Code to reduce any rate of reimbursement for services or other payments in accordance with Section 5-5e. (Source: P.A. 97-689, eff. 6-14-12; 98-463, eff. 8-16-13; 98-651, eff. 6-16-14.)