Bill Text: IL SB2541 | 2019-2020 | 101st General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

---

Bill Title: Amends the Illinois Public Aid Code. Extends the time period that a hospital can qualify as a safety-net hospital. Makes changes to provisions concerning annual assessments on inpatient services for hospital providers for the period of July 1, 2020 through December 31, 2020 and calendar years 2021 and 2022 (rather than for State fiscal years 2021 through 2024). Provides that should the change in the assessment methodology for fiscal years 2021 through December 31, 2022 not be approved on or before June 30, 2020, the assessment in effect for fiscal year 2020 shall remain in place until the new assessment is approved. Provides that if the assessment methodology for July 1, 2020 through December 31, 2022, is approved on or after July 1, 2020, it shall be retroactive to July 1, 2020, subject to federal approval and provided that certain hospital access payments authorized under the Code have the same effective date as the new assessment methodology. Contains provisions concerning an Assessment Adjustment for hospital providers beginning July 1, 2020. Provides that the Hospital Provider Fund shall make certain transfers to designated funds during State fiscal years 2021 and 2022. Contain provisions requiring the Department of Healthcare and Family Services to make hospital access payments to hospitals or to require capitated managed care organizations to make such payments for hospital services rendered on and after July 1, 2020. Provides that such hospital access payments are not due and payable until (1) certain payment methodologies are approved by the federal government in an appropriate State Plan amendment or directed payment preprint; and (2) a specified assessment is determined to be a permissible tax under the Social Security Act. Contains provisions concerning graduation medical education payments, Medicaid indirect medical education payments, and Medicaid Intern Resident Cost calculations for hospitals. Provides that critical access hospitals, safety-net hospitals, long term acute care hospitals, freestanding psychiatric hospitals, freestanding rehabilitation hospitals, and general acute care hospitals shall receive annual fee-for-service supplemental payments to be paid in 12 equal installments. Provides that certain hospitals shall receive Alzheimer's treatment access payments. Requires the Department to require managed care organizations to make directed payments and pass-through payments each calendar year. Provides that for the purpose of allocating funds included in capitation payments to managed care organizations, Illinois hospitals shall be divided into specified classes. Provides that beginning July 1, 2020, the Department shall issue payments to managed care organizations which shall be used to issue directed payments to qualified Illinois safety-net hospitals and critical access hospitals on a monthly basis. Contains provisions concerning quarterly inpatient per unit add-ons; quarterly inpatient directed payments; and quarterly outpatient per unit add-ons for specified hospitals. Sets forth specified amounts to be allocated to specified hospital class directed payment pools for the quarterly development of a uniform per unit add-on for the period July 1, 2020 through December 2020. Requires the Department to direct managed care organizations to make certain payments to general acute care hospitals, high Medicaid hospitals, long term acute care hospitals, and other specified hospitals based on each hospital's claims data for the relevant determination quarter. Requires the Department to submit certain reports to the General Assembly beginning February 1, 2022. Extends the repeal date of certain assessments and disbursements to December 31, 2022 (rather than July 1, 2020). Changes the name of the hospital transformation program to the hospital and health care transformation program. Provides that during State Fiscal Years 2021 through 2023, the hospital and health care transformation program shall be supported by an annual transformation funding pool of at least $150,000,000 to be allocated during the specified fiscal years for the purpose of facilitating hospital and health care transformation. Contains provisions concerning other matters. Amends the Illinois Administrative Procedure Act. Grants the Department of Healthcare and Family Services emergency rulemaking authority for changes made to the Illinois Public Aid Code by the amendatory Act. Amends the Illinois Health Facilities Planning Act. Provides that an application to close a health care facility shall only be deemed complete if it includes evidence that the health care facility provided written notice at least 30 days prior to filing the application of its intent to do so to the municipality in which it is located, the State Representative and State Senator of the district in which the health care facility is located, the State Board, the Director of Public Health, and the Director of Healthcare and Family Services. Amends the Emergency Medical Services (EMS) Systems Act. Provides that the Department of Public Health shall issue an annual Freestanding Emergency Center (FEC) license to a facility if the Department of Healthcare and Family Services has approved the conversion to an FEC (rather than certified the conversion to an FEC was approved by the Hospital Transformation Review Committee) as a project subject to the hospital's transformation in accordance with a specified provision under the Illinois Public Aid Code. Effective immediately.

Spectrum: Moderate Partisan Bill (Democrat 7-1)

Status: (Passed) 2020-07-07 - Public Act . . . . . . . . . 101-0650 [SB2541 Detail]

Download: Illinois-2019-SB2541-Enrolled.html

---

SB2541 Enrolled LRB101 18248 KTG 67690 b
AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Administrative Procedure Act is
amended by adding Section 5-45.1 as follows:
(5 ILCS 100/5-45.1 new)
Sec. 5-45.1. Emergency rulemaking. To provide for the
expeditious and timely implementation of changes made to
Articles 5, 5A, 12, and 14 of the Illinois Public Aid Code by
this amendatory Act of the 101st General Assembly, emergency
rules may be adopted in accordance with Section 5-45 by the
respective Department. The 24-month limitation on the adoption
of emergency rules does not apply to rules adopted under this
Section. The adoption of emergency rules authorized by Section
5-45 and this Section is deemed to be necessary for the public
interest, safety, and welfare.
This Section is repealed on January 1, 2026.
(5 ILCS 100/5-46.3 rep.)
Section 10. The Illinois Administrative Procedure Act is
amended by repealing Section 5-46.3.
Section 15. The Illinois Health Facilities Planning Act is

SB2541 Enrolled - 2 - LRB101 18248 KTG 67690 b
amended by changing Sections 3 and 8.7 as follows:
(20 ILCS 3960/3) (from Ch. 111 1/2, par. 1153)
(Section scheduled to be repealed on December 31, 2029)
Sec. 3. Definitions. As used in this Act:
"Health care facilities" means and includes the following
facilities, organizations, and related persons:
(1) An ambulatory surgical treatment center required
to be licensed pursuant to the Ambulatory Surgical
Treatment Center Act.
(2) An institution, place, building, or agency
required to be licensed pursuant to the Hospital Licensing
Act.
(3) Skilled and intermediate long term care facilities
licensed under the Nursing Home Care Act.
(A) If a demonstration project under the Nursing
Home Care Act applies for a certificate of need to
convert to a nursing facility, it shall meet the
licensure and certificate of need requirements in
effect as of the date of application.
(B) Except as provided in item (A) of this
subsection, this Act does not apply to facilities
granted waivers under Section 3-102.2 of the Nursing
Home Care Act.
(3.5) Skilled and intermediate care facilities
licensed under the ID/DD Community Care Act or the MC/DD

SB2541 Enrolled - 3 - LRB101 18248 KTG 67690 b
Act. No permit or exemption is required for a facility
licensed under the ID/DD Community Care Act or the MC/DD
Act prior to the reduction of the number of beds at a
facility. If there is a total reduction of beds at a
facility licensed under the ID/DD Community Care Act or the
MC/DD Act, this is a discontinuation or closure of the
facility. If a facility licensed under the ID/DD Community
Care Act or the MC/DD Act reduces the number of beds or
discontinues the facility, that facility must notify the
Board as provided in Section 14.1 of this Act.
(3.7) Facilities licensed under the Specialized Mental
Health Rehabilitation Act of 2013.
(4) Hospitals, nursing homes, ambulatory surgical
treatment centers, or kidney disease treatment centers
maintained by the State or any department or agency
thereof.
(5) Kidney disease treatment centers, including a
free-standing hemodialysis unit required to meet the
requirements of 42 CFR 494 in order to be certified for
participation in Medicare and Medicaid under Titles XVIII
and XIX of the federal Social Security Act.
(A) This Act does not apply to a dialysis facility
that provides only dialysis training, support, and
related services to individuals with end stage renal
disease who have elected to receive home dialysis.
(B) This Act does not apply to a dialysis unit

SB2541 Enrolled - 4 - LRB101 18248 KTG 67690 b
located in a licensed nursing home that offers or
provides dialysis-related services to residents with
end stage renal disease who have elected to receive
home dialysis within the nursing home.
(C) The Board, however, may require dialysis
facilities and licensed nursing homes under items (A)
and (B) of this subsection to report statistical
information on a quarterly basis to the Board to be
used by the Board to conduct analyses on the need for
proposed kidney disease treatment centers.
(6) An institution, place, building, or room used for
the performance of outpatient surgical procedures that is
leased, owned, or operated by or on behalf of an
out-of-state facility.
(7) An institution, place, building, or room used for
provision of a health care category of service, including,
but not limited to, cardiac catheterization and open heart
surgery.
(8) An institution, place, building, or room housing
major medical equipment used in the direct clinical
diagnosis or treatment of patients, and whose project cost
is in excess of the capital expenditure minimum.
"Health care facilities" does not include the following
entities or facility transactions:
(1) Federally-owned facilities.
(2) Facilities used solely for healing by prayer or

SB2541 Enrolled - 5 - LRB101 18248 KTG 67690 b
spiritual means.
(3) An existing facility located on any campus facility
as defined in Section 5-5.8b of the Illinois Public Aid
Code, provided that the campus facility encompasses 30 or
more contiguous acres and that the new or renovated
facility is intended for use by a licensed residential
facility.
(4) Facilities licensed under the Supportive
Residences Licensing Act or the Assisted Living and Shared
Housing Act.
(5) Facilities designated as supportive living
facilities that are in good standing with the program
established under Section 5-5.01a of the Illinois Public
Aid Code.
(6) Facilities established and operating under the
Alternative Health Care Delivery Act as a children's
community-based health care center alternative health care
model demonstration program or as an Alzheimer's Disease
Management Center alternative health care model
demonstration program.
(7) The closure of an entity or a portion of an entity
licensed under the Nursing Home Care Act, the Specialized
Mental Health Rehabilitation Act of 2013, the ID/DD
Community Care Act, or the MC/DD Act, with the exception of
facilities operated by a county or Illinois Veterans Homes,
that elect to convert, in whole or in part, to an assisted

SB2541 Enrolled - 6 - LRB101 18248 KTG 67690 b
living or shared housing establishment licensed under the
Assisted Living and Shared Housing Act and with the
exception of a facility licensed under the Specialized
Mental Health Rehabilitation Act of 2013 in connection with
a proposal to close a facility and re-establish the
facility in another location.
(8) Any change of ownership of a health care facility
that is licensed under the Nursing Home Care Act, the
Specialized Mental Health Rehabilitation Act of 2013, the
ID/DD Community Care Act, or the MC/DD Act, with the
exception of facilities operated by a county or Illinois
Veterans Homes. Changes of ownership of facilities
licensed under the Nursing Home Care Act must meet the
requirements set forth in Sections 3-101 through 3-119 of
the Nursing Home Care Act.
(9) (Blank). Any project the Department of Healthcare
and Family Services certifies was approved by the Hospital
Transformation Review Committee as a project subject to the
hospital's transformation under subsection (d-5) of
Section 14-12 of the Illinois Public Aid Code, provided the
hospital shall submit the certification to the Board.
Nothing in this paragraph excludes a health care facility
from the requirements of this Act after the approved
transformation project is complete. All other requirements
under this Act continue to apply. Hospitals that are not
subject to this Act under this paragraph shall notify the

SB2541 Enrolled - 7 - LRB101 18248 KTG 67690 b
Health Facilities and Services Review Board within 30 days
of the dates that bed changes or service changes occur.
With the exception of those health care facilities
specifically included in this Section, nothing in this Act
shall be intended to include facilities operated as a part of
the practice of a physician or other licensed health care
professional, whether practicing in his individual capacity or
within the legal structure of any partnership, medical or
professional corporation, or unincorporated medical or
professional group. Further, this Act shall not apply to
physicians or other licensed health care professional's
practices where such practices are carried out in a portion of
a health care facility under contract with such health care
facility by a physician or by other licensed health care
professionals, whether practicing in his individual capacity
or within the legal structure of any partnership, medical or
professional corporation, or unincorporated medical or
professional groups, unless the entity constructs, modifies,
or establishes a health care facility as specifically defined
in this Section. This Act shall apply to construction or
modification and to establishment by such health care facility
of such contracted portion which is subject to facility
licensing requirements, irrespective of the party responsible
for such action or attendant financial obligation.
"Person" means any one or more natural persons, legal
entities, governmental bodies other than federal, or any

SB2541 Enrolled - 8 - LRB101 18248 KTG 67690 b
combination thereof.
"Consumer" means any person other than a person (a) whose
major occupation currently involves or whose official capacity
within the last 12 months has involved the providing,
administering or financing of any type of health care facility,
(b) who is engaged in health research or the teaching of
health, (c) who has a material financial interest in any
activity which involves the providing, administering or
financing of any type of health care facility, or (d) who is or
ever has been a member of the immediate family of the person
defined by item (a), (b), or (c).
"State Board" or "Board" means the Health Facilities and
Services Review Board.
"Construction or modification" means the establishment,
erection, building, alteration, reconstruction, modernization,
improvement, extension, discontinuation, change of ownership,
of or by a health care facility, or the purchase or acquisition
by or through a health care facility of equipment or service
for diagnostic or therapeutic purposes or for facility
administration or operation, or any capital expenditure made by
or on behalf of a health care facility which exceeds the
capital expenditure minimum; however, any capital expenditure
made by or on behalf of a health care facility for (i) the
construction or modification of a facility licensed under the
Assisted Living and Shared Housing Act or (ii) a conversion
project undertaken in accordance with Section 30 of the Older

SB2541 Enrolled - 9 - LRB101 18248 KTG 67690 b
Adult Services Act shall be excluded from any obligations under
this Act.
"Establish" means the construction of a health care
facility or the replacement of an existing facility on another
site or the initiation of a category of service.
"Major medical equipment" means medical equipment which is
used for the provision of medical and other health services and
which costs in excess of the capital expenditure minimum,
except that such term does not include medical equipment
acquired by or on behalf of a clinical laboratory to provide
clinical laboratory services if the clinical laboratory is
independent of a physician's office and a hospital and it has
been determined under Title XVIII of the Social Security Act to
meet the requirements of paragraphs (10) and (11) of Section
1861(s) of such Act. In determining whether medical equipment
has a value in excess of the capital expenditure minimum, the
value of studies, surveys, designs, plans, working drawings,
specifications, and other activities essential to the
acquisition of such equipment shall be included.
"Capital expenditure" means an expenditure: (A) made by or
on behalf of a health care facility (as such a facility is
defined in this Act); and (B) which under generally accepted
accounting principles is not properly chargeable as an expense
of operation and maintenance, or is made to obtain by lease or
comparable arrangement any facility or part thereof or any
equipment for a facility or part; and which exceeds the capital

SB2541 Enrolled - 10 - LRB101 18248 KTG 67690 b
expenditure minimum.
For the purpose of this paragraph, the cost of any studies,
surveys, designs, plans, working drawings, specifications, and
other activities essential to the acquisition, improvement,
expansion, or replacement of any plant or equipment with
respect to which an expenditure is made shall be included in
determining if such expenditure exceeds the capital
expenditures minimum. Unless otherwise interdependent, or
submitted as one project by the applicant, components of
construction or modification undertaken by means of a single
construction contract or financed through the issuance of a
single debt instrument shall not be grouped together as one
project. Donations of equipment or facilities to a health care
facility which if acquired directly by such facility would be
subject to review under this Act shall be considered capital
expenditures, and a transfer of equipment or facilities for
less than fair market value shall be considered a capital
expenditure for purposes of this Act if a transfer of the
equipment or facilities at fair market value would be subject
to review.
"Capital expenditure minimum" means $11,500,000 for
projects by hospital applicants, $6,500,000 for applicants for
projects related to skilled and intermediate care long-term
care facilities licensed under the Nursing Home Care Act, and
$3,000,000 for projects by all other applicants, which shall be
annually adjusted to reflect the increase in construction costs

SB2541 Enrolled - 11 - LRB101 18248 KTG 67690 b
due to inflation, for major medical equipment and for all other
capital expenditures.
"Financial commitment" means the commitment of at least 33%
of total funds assigned to cover total project cost, which
occurs by the actual expenditure of 33% or more of the total
project cost or the commitment to expend 33% or more of the
total project cost by signed contracts or other legal means.
"Non-clinical service area" means an area (i) for the
benefit of the patients, visitors, staff, or employees of a
health care facility and (ii) not directly related to the
diagnosis, treatment, or rehabilitation of persons receiving
services from the health care facility. "Non-clinical service
areas" include, but are not limited to, chapels; gift shops;
news stands; computer systems; tunnels, walkways, and
elevators; telephone systems; projects to comply with life
safety codes; educational facilities; student housing;
patient, employee, staff, and visitor dining areas;
administration and volunteer offices; modernization of
structural components (such as roof replacement and masonry
work); boiler repair or replacement; vehicle maintenance and
storage facilities; parking facilities; mechanical systems for
heating, ventilation, and air conditioning; loading docks; and
repair or replacement of carpeting, tile, wall coverings,
window coverings or treatments, or furniture. Solely for the
purpose of this definition, "non-clinical service area" does
not include health and fitness centers.

SB2541 Enrolled - 12 - LRB101 18248 KTG 67690 b
"Areawide" means a major area of the State delineated on a
geographic, demographic, and functional basis for health
planning and for health service and having within it one or
more local areas for health planning and health service. The
term "region", as contrasted with the term "subregion", and the
word "area" may be used synonymously with the term "areawide".
"Local" means a subarea of a delineated major area that on
a geographic, demographic, and functional basis may be
considered to be part of such major area. The term "subregion"
may be used synonymously with the term "local".
"Physician" means a person licensed to practice in
accordance with the Medical Practice Act of 1987, as amended.
"Licensed health care professional" means a person
licensed to practice a health profession under pertinent
licensing statutes of the State of Illinois.
"Director" means the Director of the Illinois Department of
Public Health.
"Agency" or "Department" means the Illinois Department of
Public Health.
"Alternative health care model" means a facility or program
authorized under the Alternative Health Care Delivery Act.
"Out-of-state facility" means a person that is both (i)
licensed as a hospital or as an ambulatory surgery center under
the laws of another state or that qualifies as a hospital or an
ambulatory surgery center under regulations adopted pursuant
to the Social Security Act and (ii) not licensed under the

SB2541 Enrolled - 13 - LRB101 18248 KTG 67690 b
Ambulatory Surgical Treatment Center Act, the Hospital
Licensing Act, or the Nursing Home Care Act. Affiliates of
out-of-state facilities shall be considered out-of-state
facilities. Affiliates of Illinois licensed health care
facilities 100% owned by an Illinois licensed health care
facility, its parent, or Illinois physicians licensed to
practice medicine in all its branches shall not be considered
out-of-state facilities. Nothing in this definition shall be
construed to include an office or any part of an office of a
physician licensed to practice medicine in all its branches in
Illinois that is not required to be licensed under the
Ambulatory Surgical Treatment Center Act.
"Change of ownership of a health care facility" means a
change in the person who has ownership or control of a health
care facility's physical plant and capital assets. A change in
ownership is indicated by the following transactions: sale,
transfer, acquisition, lease, change of sponsorship, or other
means of transferring control.
"Related person" means any person that: (i) is at least 50%
owned, directly or indirectly, by either the health care
facility or a person owning, directly or indirectly, at least
50% of the health care facility; or (ii) owns, directly or
indirectly, at least 50% of the health care facility.
"Charity care" means care provided by a health care
facility for which the provider does not expect to receive
payment from the patient or a third-party payer.

SB2541 Enrolled - 14 - LRB101 18248 KTG 67690 b
"Freestanding emergency center" means a facility subject
to licensure under Section 32.5 of the Emergency Medical
Services (EMS) Systems Act.
"Category of service" means a grouping by generic class of
various types or levels of support functions, equipment, care,
or treatment provided to patients or residents, including, but
not limited to, classes such as medical-surgical, pediatrics,
or cardiac catheterization. A category of service may include
subcategories or levels of care that identify a particular
degree or type of care within the category of service. Nothing
in this definition shall be construed to include the practice
of a physician or other licensed health care professional while
functioning in an office providing for the care, diagnosis, or
treatment of patients. A category of service that is subject to
the Board's jurisdiction must be designated in rules adopted by
the Board.
"State Board Staff Report" means the document that sets
forth the review and findings of the State Board staff, as
prescribed by the State Board, regarding applications subject
to Board jurisdiction.
(Source: P.A. 100-518, eff. 6-1-18; 100-581, eff. 3-12-18;
100-957, eff. 8-19-18; 101-81, eff. 7-12-19.)
(20 ILCS 3960/8.7)
(Section scheduled to be repealed on December 31, 2029)
Sec. 8.7. Application for permit for discontinuation of a

SB2541 Enrolled - 15 - LRB101 18248 KTG 67690 b
health care facility or category of service; public notice and
public hearing.
(a) Upon a finding that an application to close a health
care facility or discontinue a category of service is complete,
the State Board shall publish a legal notice on 3 consecutive
days in a newspaper of general circulation in the area or
community to be affected and afford the public an opportunity
to request a hearing. If the application is for a facility
located in a Metropolitan Statistical Area, an additional legal
notice shall be published in a newspaper of limited
circulation, if one exists, in the area in which the facility
is located. If the newspaper of limited circulation is
published on a daily basis, the additional legal notice shall
be published on 3 consecutive days. The legal notice shall also
be posted on the Health Facilities and Services Review Board's
website and sent to the State Representative and State Senator
of the district in which the health care facility is located.
In addition, the health care facility shall provide notice of
closure to the local media that the health care facility would
routinely notify about facility events.
An application to close a health care facility shall only
be deemed complete if it includes evidence that the health care
facility provided written notice at least 30 days prior to
filing the application of its intent to do so to the
municipality in which it is located, the State Representative
and State Senator of the district in which the health care

SB2541 Enrolled - 16 - LRB101 18248 KTG 67690 b
facility is located, the State Board, the Director of Public
Health, and the Director of Healthcare and Family Services. The
changes made to this subsection by this amendatory Act of the
101st General Assembly shall apply to all applications
submitted after the effective date of this amendatory Act of
the 101st General Assembly.
(b) No later than 30 days after issuance of a permit to
close a health care facility or discontinue a category of
service, the permit holder shall give written notice of the
closure or discontinuation to the State Senator and State
Representative serving the legislative district in which the
health care facility is located.
(c) If there is a pending lawsuit that challenges an
application to discontinue a health care facility that either
names the Board as a party or alleges fraud in the filing of
the application, the Board may defer action on the application
for up to 6 months after the date of the initial deferral of
the application.
(d) The changes made to this Section by this amendatory Act
of the 101st General Assembly shall apply to all applications
submitted after the effective date of this amendatory Act of
the 101st General Assembly.
(Source: P.A. 101-83, eff. 7-15-19.)
Section 20. The State Finance Act is amended by changing
Section 6z-81 as follows:

SB2541 Enrolled - 17 - LRB101 18248 KTG 67690 b
(30 ILCS 105/6z-81)
Sec. 6z-81. Healthcare Provider Relief Fund.
(a) There is created in the State treasury a special fund
to be known as the Healthcare Provider Relief Fund.
(b) The Fund is created for the purpose of receiving and
disbursing moneys in accordance with this Section.
Disbursements from the Fund shall be made only as follows:
(1) Subject to appropriation, for payment by the
Department of Healthcare and Family Services or by the
Department of Human Services of medical bills and related
expenses, including administrative expenses, for which the
State is responsible under Titles XIX and XXI of the Social
Security Act, the Illinois Public Aid Code, the Children's
Health Insurance Program Act, the Covering ALL KIDS Health
Insurance Act, and the Long Term Acute Care Hospital
Quality Improvement Transfer Program Act.
(2) For repayment of funds borrowed from other State
funds or from outside sources, including interest thereon.
(3) For State fiscal years 2017, 2018, and 2019, for
making payments to the human poison control center pursuant
to Section 12-4.105 of the Illinois Public Aid Code.
(c) The Fund shall consist of the following:
(1) Moneys received by the State from short-term
borrowing pursuant to the Short Term Borrowing Act on or
after the effective date of Public Act 96-820.

SB2541 Enrolled - 18 - LRB101 18248 KTG 67690 b
(2) All federal matching funds received by the Illinois
Department of Healthcare and Family Services as a result of
expenditures made by the Department that are attributable
to moneys deposited in the Fund.
(3) All federal matching funds received by the Illinois
Department of Healthcare and Family Services as a result of
federal approval of Title XIX State plan amendment
transmittal number 07-09.
(3.5) Proceeds from the assessment authorized under
Article V-H of the Illinois Public Aid Code.
(4) All other moneys received for the Fund from any
other source, including interest earned thereon.
(5) All federal matching funds received by the Illinois
Department of Healthcare and Family Services as a result of
expenditures made by the Department for Medical Assistance
from the General Revenue Fund, the Tobacco Settlement
Recovery Fund, the Long-Term Care Provider Fund, and the
Drug Rebate Fund related to individuals eligible for
medical assistance pursuant to the Patient Protection and
Affordable Care Act (P.L. 111-148) and Section 5-2 of the
Illinois Public Aid Code.
(d) In addition to any other transfers that may be provided
for by law, on the effective date of Public Act 97-44, or as
soon thereafter as practical, the State Comptroller shall
direct and the State Treasurer shall transfer the sum of
$365,000,000 from the General Revenue Fund into the Healthcare

SB2541 Enrolled - 19 - LRB101 18248 KTG 67690 b
Provider Relief Fund.
(e) In addition to any other transfers that may be provided
for by law, on July 1, 2011, or as soon thereafter as
practical, the State Comptroller shall direct and the State
Treasurer shall transfer the sum of $160,000,000 from the
General Revenue Fund to the Healthcare Provider Relief Fund.
(f) Notwithstanding any other State law to the contrary,
and in addition to any other transfers that may be provided for
by law, the State Comptroller shall order transferred and the
State Treasurer shall transfer $500,000,000 to the Healthcare
Provider Relief Fund from the General Revenue Fund in equal
monthly installments of $100,000,000, with the first transfer
to be made on July 1, 2012, or as soon thereafter as practical,
and with each of the remaining transfers to be made on August
1, 2012, September 1, 2012, October 1, 2012, and November 1,
2012, or as soon thereafter as practical. This transfer may
assist the Department of Healthcare and Family Services in
improving Medical Assistance bill processing timeframes or in
meeting the possible requirements of Senate Bill 3397, or other
similar legislation, of the 97th General Assembly should it
become law.
(g) Notwithstanding any other State law to the contrary,
and in addition to any other transfers that may be provided for
by law, on July 1, 2013, or as soon thereafter as may be
practical, the State Comptroller shall direct and the State
Treasurer shall transfer the sum of $601,000,000 from the

SB2541 Enrolled - 20 - LRB101 18248 KTG 67690 b
General Revenue Fund to the Healthcare Provider Relief Fund.
(Source: P.A. 100-587, eff. 6-4-18; 101-9, eff. 6-5-19; revised
7-17-19.)
Section 25. The Emergency Medical Services (EMS) Systems
Act is amended by changing Section 32.5 as follows:
(210 ILCS 50/32.5)
Sec. 32.5. Freestanding Emergency Center.
(a) The Department shall issue an annual Freestanding
Emergency Center (FEC) license to any facility that has
received a permit from the Health Facilities and Services
Review Board to establish a Freestanding Emergency Center by
January 1, 2015, and:
(1) is located: (A) in a municipality with a population
of 50,000 or fewer inhabitants; (B) within 50 miles of the
hospital that owns or controls the FEC; and (C) within 50
miles of the Resource Hospital affiliated with the FEC as
part of the EMS System;
(2) is wholly owned or controlled by an Associate or
Resource Hospital, but is not a part of the hospital's
physical plant;
(3) meets the standards for licensed FECs, adopted by
rule of the Department, including, but not limited to:
(A) facility design, specification, operation, and
maintenance standards;

SB2541 Enrolled - 21 - LRB101 18248 KTG 67690 b
(B) equipment standards; and
(C) the number and qualifications of emergency
medical personnel and other staff, which must include
at least one board certified emergency physician
present at the FEC 24 hours per day.
(4) limits its participation in the EMS System strictly
to receiving a limited number of patients by ambulance: (A)
according to the FEC's 24-hour capabilities; (B) according
to protocols developed by the Resource Hospital within the
FEC's designated EMS System; and (C) as pre-approved by
both the EMS Medical Director and the Department;
(5) provides comprehensive emergency treatment
services, as defined in the rules adopted by the Department
pursuant to the Hospital Licensing Act, 24 hours per day,
on an outpatient basis;
(6) provides an ambulance and maintains on site
ambulance services staffed with paramedics 24 hours per
day;
(7) (blank);
(8) complies with all State and federal patient rights
provisions, including, but not limited to, the Emergency
Medical Treatment Act and the federal Emergency Medical
Treatment and Active Labor Act;
(9) maintains a communications system that is fully
integrated with its Resource Hospital within the FEC's
designated EMS System;

SB2541 Enrolled - 22 - LRB101 18248 KTG 67690 b
(10) reports to the Department any patient transfers
from the FEC to a hospital within 48 hours of the transfer
plus any other data determined to be relevant by the
Department;
(11) submits to the Department, on a quarterly basis,
the FEC's morbidity and mortality rates for patients
treated at the FEC and other data determined to be relevant
by the Department;
(12) does not describe itself or hold itself out to the
general public as a full service hospital or hospital
emergency department in its advertising or marketing
activities;
(13) complies with any other rules adopted by the
Department under this Act that relate to FECs;
(14) passes the Department's site inspection for
compliance with the FEC requirements of this Act;
(15) submits a copy of the permit issued by the Health
Facilities and Services Review Board indicating that the
facility has complied with the Illinois Health Facilities
Planning Act with respect to the health services to be
provided at the facility;
(16) submits an application for designation as an FEC
in a manner and form prescribed by the Department by rule;
and
(17) pays the annual license fee as determined by the
Department by rule.

SB2541 Enrolled - 23 - LRB101 18248 KTG 67690 b
(a-5) Notwithstanding any other provision of this Section,
the Department may issue an annual FEC license to a facility
that is located in a county that does not have a licensed
general acute care hospital if the facility's application for a
permit from the Illinois Health Facilities Planning Board has
been deemed complete by the Department of Public Health by
January 1, 2014 and if the facility complies with the
requirements set forth in paragraphs (1) through (17) of
subsection (a).
(a-10) Notwithstanding any other provision of this
Section, the Department may issue an annual FEC license to a
facility if the facility has, by January 1, 2014, filed a
letter of intent to establish an FEC and if the facility
complies with the requirements set forth in paragraphs (1)
through (17) of subsection (a).
(a-15) Notwithstanding any other provision of this
Section, the Department shall issue an annual FEC license to a
facility if the facility: (i) discontinues operation as a
hospital within 180 days after December 4, 2015 (the effective
date of Public Act 99-490) this amendatory Act of the 99th
General Assembly with a Health Facilities and Services Review
Board project number of E-017-15; (ii) has an application for a
permit to establish an FEC from the Health Facilities and
Services Review Board that is deemed complete by January 1,
2017; and (iii) complies with the requirements set forth in
paragraphs (1) through (17) of subsection (a) of this Section.

SB2541 Enrolled - 24 - LRB101 18248 KTG 67690 b
(a-20) Notwithstanding any other provision of this
Section, the Department shall issue an annual FEC license to a
facility if:
(1) the facility is a hospital that has discontinued
inpatient hospital services;
(2) the Department of Healthcare and Family Services
has approved certified the conversion to an FEC was
approved by the Hospital Transformation Review Committee
as a project subject to the hospital's transformation under
subsection (d-5) of Section 14-12 of the Illinois Public
Aid Code;
(3) the facility complies with the requirements set
forth in paragraphs (1) through (17), provided however that
the FEC may be located in a municipality with a population
greater than 50,000 inhabitants and shall not be subject to
the requirements of the Illinois Health Facilities
Planning Act that are applicable to the conversion to an
FEC if the Department of Healthcare and Family Services
Service has approved certified the conversion to an FEC was
approved by the Hospital Transformation Review Committee
as a project subject to the hospital's transformation under
subsection (d-5) of Section 14-12 of the Illinois Public
Aid Code; and
(4) the facility is located at the same physical
location where the facility served as a hospital.
(b) The Department shall:

SB2541 Enrolled - 25 - LRB101 18248 KTG 67690 b
(1) annually inspect facilities of initial FEC
applicants and licensed FECs, and issue annual licenses to
or annually relicense FECs that satisfy the Department's
licensure requirements as set forth in subsection (a);
(2) suspend, revoke, refuse to issue, or refuse to
renew the license of any FEC, after notice and an
opportunity for a hearing, when the Department finds that
the FEC has failed to comply with the standards and
requirements of the Act or rules adopted by the Department
under the Act;
(3) issue an Emergency Suspension Order for any FEC
when the Director or his or her designee has determined
that the continued operation of the FEC poses an immediate
and serious danger to the public health, safety, and
welfare. An opportunity for a hearing shall be promptly
initiated after an Emergency Suspension Order has been
issued; and
(4) adopt rules as needed to implement this Section.
(Source: P.A. 99-490, eff. 12-4-15; 99-710, eff. 8-5-16;
100-581, eff. 3-12-18; revised 7-23-19.)
Section 30. The Illinois Public Aid Code is amended by
changing Sections 5-5e.1, 5A-2, 5A-4, 5A-8, 5A-10, 5A-13,
5A-14, 12-4.105, and 14-12 and by adding Sections 5-5.05c,
5A-12.7, 5A-12.8, and 5A-17 as follows:

SB2541 Enrolled - 26 - LRB101 18248 KTG 67690 b
(305 ILCS 5/5-5.05c new)
Sec. 5-5.05c. Access to physician services. The Department
shall increase rates of reimbursement for physician services to
as close to 60% of Medicare rates in effect as of January 1,
2020 utilizing the rates of Illinois Locality 99 facility
rates.
(305 ILCS 5/5-5e.1)
Sec. 5-5e.1. Safety-Net Hospitals.
(a) A Safety-Net Hospital is an Illinois hospital that:
(1) is licensed by the Department of Public Health as a
general acute care or pediatric hospital; and
(2) is a disproportionate share hospital, as described
in Section 1923 of the federal Social Security Act, as
determined by the Department; and
(3) meets one of the following:
(A) has a MIUR of at least 40% and a charity
percent of at least 4%; or
(B) has a MIUR of at least 50%.
(b) Definitions. As used in this Section:
(1) "Charity percent" means the ratio of (i) the
hospital's charity charges for services provided to
individuals without health insurance or another source of
third party coverage to (ii) the Illinois total hospital
charges, each as reported on the hospital's OBRA form.
(2) "MIUR" means Medicaid Inpatient Utilization Rate

SB2541 Enrolled - 27 - LRB101 18248 KTG 67690 b
and is defined as a fraction, the numerator of which is the
number of a hospital's inpatient days provided in the
hospital's fiscal year ending 3 years prior to the rate
year, to patients who, for such days, were eligible for
Medicaid under Title XIX of the federal Social Security
Act, 42 USC 1396a et seq., excluding those persons eligible
for medical assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
Section 5-2 of this Article, and the denominator of which
is the total number of the hospital's inpatient days in
that same period, excluding those persons eligible for
medical assistance pursuant to 42 U.S.C.
1396a(a)(10)(A)(i)(VIII) as set forth in paragraph 18 of
Section 5-2 of this Article.
(3) "OBRA form" means form HFS-3834, OBRA '93 data
collection form, for the rate year.
(4) "Rate year" means the 12-month period beginning on
October 1.
(c) Beginning July 1, 2012 and ending on December 31, 2022
June 30, 2020, a hospital that would have qualified for the
rate year beginning October 1, 2011, shall be a Safety-Net
Hospital.
(d) No later than August 15 preceding the rate year, each
hospital shall submit the OBRA form to the Department. Prior to
October 1, the Department shall notify each hospital whether it
has qualified as a Safety-Net Hospital.

SB2541 Enrolled - 28 - LRB101 18248 KTG 67690 b
(e) The Department may promulgate rules in order to
implement this Section.
(f) Nothing in this Section shall be construed as limiting
the ability of the Department to include the Safety-Net
Hospitals in the hospital rate reform mandated by Section 14-11
of this Code and implemented under Section 14-12 of this Code
and by administrative rulemaking.
(Source: P.A. 100-581, eff. 3-12-18.)
(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2)
(Section scheduled to be repealed on July 1, 2020)
Sec. 5A-2. Assessment.
(a)(1) Subject to Sections 5A-3 and 5A-10, for State fiscal
years 2009 through 2018, or as long as continued under Section
5A-16, an annual assessment on inpatient services is imposed on
each hospital provider in an amount equal to $218.38 multiplied
by the difference of the hospital's occupied bed days less the
hospital's Medicare bed days, provided, however, that the
amount of $218.38 shall be increased by a uniform percentage to
generate an amount equal to 75% of the State share of the
payments authorized under Section 5A-12.5, with such increase
only taking effect upon the date that a State share for such
payments is required under federal law. For the period of April
through June 2015, the amount of $218.38 used to calculate the
assessment under this paragraph shall, by emergency rule under
subsection (s) of Section 5-45 of the Illinois Administrative

SB2541 Enrolled - 29 - LRB101 18248 KTG 67690 b
Procedure Act, be increased by a uniform percentage to generate
$20,250,000 in the aggregate for that period from all hospitals
subject to the annual assessment under this paragraph.
(2) In addition to any other assessments imposed under this
Article, effective July 1, 2016 and semi-annually thereafter
through June 2018, or as provided in Section 5A-16, in addition
to any federally required State share as authorized under
paragraph (1), the amount of $218.38 shall be increased by a
uniform percentage to generate an amount equal to 75% of the
ACA Assessment Adjustment, as defined in subsection (b-6) of
this Section.
For State fiscal years 2009 through 2018, or as provided in
Section 5A-16, a hospital's occupied bed days and Medicare bed
days shall be determined using the most recent data available
from each hospital's 2005 Medicare cost report as contained in
the Healthcare Cost Report Information System file, for the
quarter ending on December 31, 2006, without regard to any
subsequent adjustments or changes to such data. If a hospital's
2005 Medicare cost report is not contained in the Healthcare
Cost Report Information System, then the Illinois Department
may obtain the hospital provider's occupied bed days and
Medicare bed days from any source available, including, but not
limited to, records maintained by the hospital provider, which
may be inspected at all times during business hours of the day
by the Illinois Department or its duly authorized agents and
employees.

SB2541 Enrolled - 30 - LRB101 18248 KTG 67690 b
(3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on inpatient
services is imposed on each hospital provider in an amount
equal to $197.19 multiplied by the difference of the hospital's
occupied bed days less the hospital's Medicare bed days;
however, for State fiscal year 2021, the amount of $197.19
shall be increased by a uniform percentage to generate an
additional $6,250,000 in the aggregate for that period from all
hospitals subject to the annual assessment under this
paragraph. For State fiscal years 2019 and 2020, a hospital's
occupied bed days and Medicare bed days shall be determined
using the most recent data available from each hospital's 2015
Medicare cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on March 31,
2017, without regard to any subsequent adjustments or changes
to such data. If a hospital's 2015 Medicare cost report is not
contained in the Healthcare Cost Report Information System,
then the Illinois Department may obtain the hospital provider's
occupied bed days and Medicare bed days from any source
available, including, but not limited to, records maintained by
the hospital provider, which may be inspected at all times
during business hours of the day by the Illinois Department or
its duly authorized agents and employees. Notwithstanding any
other provision in this Article, for a hospital provider that
did not have a 2015 Medicare cost report, but paid an
assessment in State fiscal year 2018 on the basis of

SB2541 Enrolled - 31 - LRB101 18248 KTG 67690 b
hypothetical data, that assessment amount shall be used for
State fiscal years 2019 and 2020; however, for State fiscal
year 2021, the assessment amount shall be increased by the
proportion that it represents of the total annual assessment
that is generated from all hospitals in order to generate
$6,250,000 in the aggregate for that period from all hospitals
subject to the annual assessment under this paragraph.
(4) Subject to Sections 5A-3 and 5A-10, for the period of
July 1, 2020 through December 31, 2020 and calendar State
fiscal years 2021 and 2022 through 2024, an annual assessment
on inpatient services is imposed on each hospital provider in
an amount equal to $221.50 $197.19 multiplied by the difference
of the hospital's occupied bed days less the hospital's
Medicare bed days, provided however: for the period of July 1,
2020 through December 31, 2020, (i) the assessment shall be
equal to 50% of the annual amount; and (ii) the amount of
$221.50 shall be retroactively adjusted by a uniform percentage
to generate an amount equal to 50% of the Assessment
Adjustment, as defined in subsection (b-7) , that the amount of
$197.19 used to calculate the assessment under this paragraph
shall, by rule, be adjusted by a uniform percentage to generate
the same total annual assessment that was generated in State
fiscal year 2020 from all hospitals subject to the annual
assessment under this paragraph plus $6,250,000. For the period
of July 1, 2020 through December 31, 2020 and calendar State
fiscal years 2021 and 2022, a hospital's occupied bed days and

SB2541 Enrolled - 32 - LRB101 18248 KTG 67690 b
Medicare bed days shall be determined using the most recent
data available from each hospital's 2015 2017 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on March 31, 2017 2019,
without regard to any subsequent adjustments or changes to such
data. If a hospital's 2015 Medicare cost report is not
contained in the Healthcare Cost Report Information System,
then the Illinois Department may obtain the hospital provider's
occupied bed days and Medicare bed days from any source
available, including, but not limited to, records maintained by
the hospital provider, which may be inspected at all times
during business hours of the day by the Illinois Department or
its duly authorized agents and employees. Should the change in
the assessment methodology for fiscal years 2021 through
December 31, 2022 not be approved on or before June 30, 2020,
the assessment and payments under this Article in effect for
fiscal year 2020 shall remain in place until the new assessment
is approved. If the assessment methodology for July 1, 2020
through December 31, 2022, is approved on or after July 1,
2020, it shall be retroactive to July 1, 2020, subject to
federal approval and provided that the payments authorized
under Section 5A-12.7 have the same effective date as the new
assessment methodology. In giving retroactive effect to the
assessment approved after June 30, 2020, credit toward the new
assessment shall be given for any payments of the previous
assessment for periods after June 30, 2020. Notwithstanding any

SB2541 Enrolled - 33 - LRB101 18248 KTG 67690 b
other provision of this Article, for a hospital provider that
did not have a 2015 Medicare cost report, but paid an
assessment in State Fiscal Year 2020 on the basis of
hypothetical data, the data that was the basis for the 2020
assessment shall be used to calculate the assessment under this
paragraph. For State fiscal years 2023 and 2024, a hospital's
occupied bed days and Medicare bed days shall be determined
using the most recent data available from each hospital's 2019
Medicare cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on March 31,
2021, without regard to any subsequent adjustments or changes
to such data.
(b) (Blank).
(b-5)(1) Subject to Sections 5A-3 and 5A-10, for the
portion of State fiscal year 2012, beginning June 10, 2012
through June 30, 2012, and for State fiscal years 2013 through
2018, or as provided in Section 5A-16, an annual assessment on
outpatient services is imposed on each hospital provider in an
amount equal to .008766 multiplied by the hospital's outpatient
gross revenue, provided, however, that the amount of .008766
shall be increased by a uniform percentage to generate an
amount equal to 25% of the State share of the payments
authorized under Section 5A-12.5, with such increase only
taking effect upon the date that a State share for such
payments is required under federal law. For the period
beginning June 10, 2012 through June 30, 2012, the annual

SB2541 Enrolled - 34 - LRB101 18248 KTG 67690 b
assessment on outpatient services shall be prorated by
multiplying the assessment amount by a fraction, the numerator
of which is 21 days and the denominator of which is 365 days.
For the period of April through June 2015, the amount of
.008766 used to calculate the assessment under this paragraph
shall, by emergency rule under subsection (s) of Section 5-45
of the Illinois Administrative Procedure Act, be increased by a
uniform percentage to generate $6,750,000 in the aggregate for
that period from all hospitals subject to the annual assessment
under this paragraph.
(2) In addition to any other assessments imposed under this
Article, effective July 1, 2016 and semi-annually thereafter
through June 2018, in addition to any federally required State
share as authorized under paragraph (1), the amount of .008766
shall be increased by a uniform percentage to generate an
amount equal to 25% of the ACA Assessment Adjustment, as
defined in subsection (b-6) of this Section.
For the portion of State fiscal year 2012, beginning June
10, 2012 through June 30, 2012, and State fiscal years 2013
through 2018, or as provided in Section 5A-16, a hospital's
outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2009 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on June 30, 2011, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2009 Medicare cost report is not contained in

SB2541 Enrolled - 35 - LRB101 18248 KTG 67690 b
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
revenue from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the
Department or its duly authorized agents and employees.
(3) Subject to Sections 5A-3, 5A-10, and 5A-16, for State
fiscal years 2019 and 2020, an annual assessment on outpatient
services is imposed on each hospital provider in an amount
equal to .01358 multiplied by the hospital's outpatient gross
revenue; however, for State fiscal year 2021, the amount of
.01358 shall be increased by a uniform percentage to generate
an additional $6,250,000 in the aggregate for that period from
all hospitals subject to the annual assessment under this
paragraph. For State fiscal years 2019 and 2020, a hospital's
outpatient gross revenue shall be determined using the most
recent data available from each hospital's 2015 Medicare cost
report as contained in the Healthcare Cost Report Information
System file, for the quarter ending on March 31, 2017, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2015 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Department may obtain the hospital provider's outpatient gross
revenue from any source available, including, but not limited
to, records maintained by the hospital provider, which may be
inspected at all times during business hours of the day by the

SB2541 Enrolled - 36 - LRB101 18248 KTG 67690 b
Department or its duly authorized agents and employees.
Notwithstanding any other provision in this Article, for a
hospital provider that did not have a 2015 Medicare cost
report, but paid an assessment in State fiscal year 2018 on the
basis of hypothetical data, that assessment amount shall be
used for State fiscal years 2019 and 2020; however, for State
fiscal year 2021, the assessment amount shall be increased by
the proportion that it represents of the total annual
assessment that is generated from all hospitals in order to
generate $6,250,000 in the aggregate for that period from all
hospitals subject to the annual assessment under this
paragraph.
(4) Subject to Sections 5A-3 and 5A-10, for the period of
July 1, 2020 through December 31, 2020 and calendar State
fiscal years 2021 and 2022 through 2024, an annual assessment
on outpatient services is imposed on each hospital provider in
an amount equal to .01525 .01358 multiplied by the hospital's
outpatient gross revenue, provided however: (i) for the period
of July 1, 2020 through December 31, 2020, the assessment shall
be equal to 50% of the annual amount; and (ii) the amount of
.01525 shall be retroactively adjusted by a uniform percentage
to generate an amount equal to 50% of the Assessment
Adjustment, as defined in subsection (b-7) , that the amount of
.01358 used to calculate the assessment under this paragraph
shall, by rule, be adjusted by a uniform percentage to generate
the same total annual assessment that was generated in State

SB2541 Enrolled - 37 - LRB101 18248 KTG 67690 b
fiscal year 2020 from all hospitals subject to the annual
assessment under this paragraph plus $6,250,000. For the period
of July 1, 2020 through December 31, 2020 and calendar State
fiscal years 2021 and 2022, a hospital's outpatient gross
revenue shall be determined using the most recent data
available from each hospital's 2015 2017 Medicare cost report
as contained in the Healthcare Cost Report Information System
file, for the quarter ending on March 31, 2017 2019, without
regard to any subsequent adjustments or changes to such data.
If a hospital's 2015 Medicare cost report is not contained in
the Healthcare Cost Report Information System, then the
Illinois Department may obtain the hospital provider's
outpatient revenue data from any source available, including,
but not limited to, records maintained by the hospital
provider, which may be inspected at all times during business
hours of the day by the Illinois Department or its duly
authorized agents and employees. Should the change in the
assessment methodology above for fiscal years 2021 through
calendar year 2022 not be approved prior to July 1, 2020, the
assessment and payments under this Article in effect for fiscal
year 2020 shall remain in place until the new assessment is
approved. If the change in the assessment methodology above for
July 1, 2020 through December 31, 2022, is approved after June
30, 2020, it shall have a retroactive effective date of July 1,
2020, subject to federal approval and provided that the
payments authorized under Section 12A-7 have the same effective

SB2541 Enrolled - 38 - LRB101 18248 KTG 67690 b
date as the new assessment methodology. In giving retroactive
effect to the assessment approved after June 30, 2020, credit
toward the new assessment shall be given for any payments of
the previous assessment for periods after June 30, 2020.
Notwithstanding any other provision of this Article, for a
hospital provider that did not have a 2015 Medicare cost
report, but paid an assessment in State Fiscal Year 2020 on the
basis of hypothetical data, the data that was the basis for the
2020 assessment shall be used to calculate the assessment under
this paragraph. For State fiscal years 2023 and 2024, a
hospital's outpatient gross revenue shall be determined using
the most recent data available from each hospital's 2019
Medicare cost report as contained in the Healthcare Cost Report
Information System file, for the quarter ending on March 31,
2021, without regard to any subsequent adjustments or changes
to such data.
(b-6)(1) As used in this Section, "ACA Assessment
Adjustment" means:
(A) For the period of July 1, 2016 through December 31,
2016, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of April 2016 multiplied by 6.
(B) For the period of January 1, 2017 through June 30,

SB2541 Enrolled - 39 - LRB101 18248 KTG 67690 b
2017, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of October 2016 multiplied by 6, except that the
amount calculated under this subparagraph (B) shall be
adjusted, either positively or negatively, to account for
the difference between the actual payments issued under
Section 5A-12.5 for the period beginning July 1, 2016
through December 31, 2016 and the estimated payments due
and payable in the month of April 2016 multiplied by 6 as
described in subparagraph (A).
(C) For the period of July 1, 2017 through December 31,
2017, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of April 2017 multiplied by 6, except that the amount
calculated under this subparagraph (C) shall be adjusted,
either positively or negatively, to account for the
difference between the actual payments issued under
Section 5A-12.5 for the period beginning January 1, 2017
through June 30, 2017 and the estimated payments due and
payable in the month of October 2016 multiplied by 6 as

SB2541 Enrolled - 40 - LRB101 18248 KTG 67690 b
described in subparagraph (B).
(D) For the period of January 1, 2018 through June 30,
2018, the product of .19125 multiplied by the sum of the
fee-for-service payments to hospitals as authorized under
Section 5A-12.5 and the adjustments authorized under
subsection (t) of Section 5A-12.2 to managed care
organizations for hospital services due and payable in the
month of October 2017 multiplied by 6, except that:
(i) the amount calculated under this subparagraph
(D) shall be adjusted, either positively or
negatively, to account for the difference between the
actual payments issued under Section 5A-12.5 for the
period of July 1, 2017 through December 31, 2017 and
the estimated payments due and payable in the month of
April 2017 multiplied by 6 as described in subparagraph
(C); and
(ii) the amount calculated under this subparagraph
(D) shall be adjusted to include the product of .19125
multiplied by the sum of the fee-for-service payments,
if any, estimated to be paid to hospitals under
subsection (b) of Section 5A-12.5.
(2) The Department shall complete and apply a final
reconciliation of the ACA Assessment Adjustment prior to June
30, 2018 to account for:
(A) any differences between the actual payments issued
or scheduled to be issued prior to June 30, 2018 as

SB2541 Enrolled - 41 - LRB101 18248 KTG 67690 b
authorized in Section 5A-12.5 for the period of January 1,
2018 through June 30, 2018 and the estimated payments due
and payable in the month of October 2017 multiplied by 6 as
described in subparagraph (D); and
(B) any difference between the estimated
fee-for-service payments under subsection (b) of Section
5A-12.5 and the amount of such payments that are actually
scheduled to be paid.
The Department shall notify hospitals of any additional
amounts owed or reduction credits to be applied to the June
2018 ACA Assessment Adjustment. This is to be considered the
final reconciliation for the ACA Assessment Adjustment.
(3) Notwithstanding any other provision of this Section, if
for any reason the scheduled payments under subsection (b) of
Section 5A-12.5 are not issued in full by the final day of the
period authorized under subsection (b) of Section 5A-12.5,
funds collected from each hospital pursuant to subparagraph (D)
of paragraph (1) and pursuant to paragraph (2), attributable to
the scheduled payments authorized under subsection (b) of
Section 5A-12.5 that are not issued in full by the final day of
the period attributable to each payment authorized under
subsection (b) of Section 5A-12.5, shall be refunded.
(4) The increases authorized under paragraph (2) of
subsection (a) and paragraph (2) of subsection (b-5) shall be
limited to the federally required State share of the total
payments authorized under Section 5A-12.5 if the sum of such

SB2541 Enrolled - 42 - LRB101 18248 KTG 67690 b
payments yields an annualized amount equal to or less than
$450,000,000, or if the adjustments authorized under
subsection (t) of Section 5A-12.2 are found not to be
actuarially sound; however, this limitation shall not apply to
the fee-for-service payments described in subsection (b) of
Section 5A-12.5.
(b-7)(1) As used in this Section, "Assessment Adjustment"
means:
(A) For the period of July 1, 2020 through December 31,
2020, the product of .3853 multiplied by the total of the
actual payments made under subsections (c) through (k) of
Section 5A-12.7 attributable to the period, less the total
of the assessment imposed under subsections (a) and (b-5)
of this Section for the period.
(B) For each calendar quarter beginning on and after
January 1, 2021, the product of .3853 multiplied by the
total of the actual payments made under subsections (c)
through (k) of Section 5A-12.7 attributable to the period,
less the total of the assessment imposed under subsections
(a) and (b-5) of this Section for the period.
(2) The Department shall calculate and notify each hospital
of the total Assessment Adjustment and any additional
assessment owed by the hospital or refund owed to the hospital
on either a semi-annual or annual basis. Such notice shall be
issued at least 30 days prior to any period in which the
assessment will be adjusted. Any additional assessment owed by

SB2541 Enrolled - 43 - LRB101 18248 KTG 67690 b
the hospital or refund owed to the hospital shall be uniformly
applied to the assessment owed by the hospital in monthly
installments for the subsequent semi-annual period or calendar
year. If no assessment is owed in the subsequent year, any
amount owed by the hospital or refund due to the hospital,
shall be paid in a lump sum.
(3) The Department shall publish all details of the
Assessment Adjustment calculation performed each year on its
website within 30 days of completing the calculation, and also
submit the details of the Assessment Adjustment calculation as
part of the Department's annual report to the General Assembly.
(c) (Blank).
(d) Notwithstanding any of the other provisions of this
Section, the Department is authorized to adopt rules to reduce
the rate of any annual assessment imposed under this Section,
as authorized by Section 5-46.2 of the Illinois Administrative
Procedure Act.
(e) Notwithstanding any other provision of this Section,
any plan providing for an assessment on a hospital provider as
a permissible tax under Title XIX of the federal Social
Security Act and Medicaid-eligible payments to hospital
providers from the revenues derived from that assessment shall
be reviewed by the Illinois Department of Healthcare and Family
Services, as the Single State Medicaid Agency required by
federal law, to determine whether those assessments and
hospital provider payments meet federal Medicaid standards. If

SB2541 Enrolled - 44 - LRB101 18248 KTG 67690 b
the Department determines that the elements of the plan may
meet federal Medicaid standards and a related State Medicaid
Plan Amendment is prepared in a manner and form suitable for
submission, that State Plan Amendment shall be submitted in a
timely manner for review by the Centers for Medicare and
Medicaid Services of the United States Department of Health and
Human Services and subject to approval by the Centers for
Medicare and Medicaid Services of the United States Department
of Health and Human Services. No such plan shall become
effective without approval by the Illinois General Assembly by
the enactment into law of related legislation. Notwithstanding
any other provision of this Section, the Department is
authorized to adopt rules to reduce the rate of any annual
assessment imposed under this Section. Any such rules may be
adopted by the Department under Section 5-50 of the Illinois
Administrative Procedure Act.
(Source: P.A. 100-581, eff. 3-12-18; 101-10, eff. 6-5-19.)
(305 ILCS 5/5A-4) (from Ch. 23, par. 5A-4)
Sec. 5A-4. Payment of assessment; penalty.
(a) The assessment imposed by Section 5A-2 for State fiscal
year 2009 through State fiscal year 2018 or as provided in
Section 5A-16, shall be due and payable in monthly
installments, each equaling one-twelfth of the assessment for
the year, on the fourteenth State business day of each month.
No installment payment of an assessment imposed by Section 5A-2

SB2541 Enrolled - 45 - LRB101 18248 KTG 67690 b
shall be due and payable, however, until after the Comptroller
has issued the payments required under this Article.
Except as provided in subsection (a-5) of this Section, the
assessment imposed by subsection (b-5) of Section 5A-2 for the
portion of State fiscal year 2012 beginning June 10, 2012
through June 30, 2012, and for State fiscal year 2013 through
State fiscal year 2018 or as provided in Section 5A-16, shall
be due and payable in monthly installments, each equaling
one-twelfth of the assessment for the year, on the 17th State
business day of each month. No installment payment of an
assessment imposed by subsection (b-5) of Section 5A-2 shall be
due and payable, however, until after: (i) the Department
notifies the hospital provider, in writing, that the payment
methodologies to hospitals required under Section 5A-12.4,
have been approved by the Centers for Medicare and Medicaid
Services of the U.S. Department of Health and Human Services,
and the waiver under 42 CFR 433.68 for the assessment imposed
by subsection (b-5) of Section 5A-2, if necessary, has been
granted by the Centers for Medicare and Medicaid Services of
the U.S. Department of Health and Human Services; and (ii) the
Comptroller has issued the payments required under Section
5A-12.4. Upon notification to the Department of approval of the
payment methodologies required under Section 5A-12.4 and the
waiver granted under 42 CFR 433.68, if necessary, all
installments otherwise due under subsection (b-5) of Section
5A-2 prior to the date of notification shall be due and payable

SB2541 Enrolled - 46 - LRB101 18248 KTG 67690 b
to the Department upon written direction from the Department
and issuance by the Comptroller of the payments required under
Section 5A-12.4.
Except as provided in subsection (a-5) of this Section, the
assessment imposed under Section 5A-2 for State fiscal year
2019 and each subsequent State fiscal year shall be due and
payable in monthly installments, each equaling one-twelfth of
the assessment for the year, on the 17th State business day of
each month. The Department has discretion to establish a later
date due to delays in payments being made to hospitals as
required under Section 5A-12.7. No installment payment of an
assessment imposed by Section 5A-2 shall be due and payable,
however, until after: (i) the Department notifies the hospital
provider, in writing, that the payment methodologies to
hospitals required under Section 5A-12.6 or 5A-12.7 have been
approved by the Centers for Medicare and Medicaid Services of
the U.S. Department of Health and Human Services, and the
waiver under 42 CFR 433.68 for the assessment imposed by
Section 5A-2, if necessary, has been granted by the Centers for
Medicare and Medicaid Services of the U.S. Department of Health
and Human Services; and (ii) the Comptroller and managed care
organizations have has issued the payments required under
Section 5A-12.6 or 5A-12.7. Upon notification to the Department
of approval of the payment methodologies required under Section
5A-12.6 or 5A-12.7 and the waiver granted under 42 CFR 433.68,
if necessary, all installments otherwise due under Section 5A-2

SB2541 Enrolled - 47 - LRB101 18248 KTG 67690 b
prior to the date of notification shall be due and payable to
the Department upon written direction from the Department and
issuance by the Comptroller and managed care organizations of
the payments required under Section 5A-12.6 or 5A-12.7.
(a-5) The Illinois Department may accelerate the schedule
upon which assessment installments are due and payable by
hospitals with a payment ratio greater than or equal to one.
Such acceleration of due dates for payment of the assessment
may be made only in conjunction with a corresponding
acceleration in access payments identified in Section 5A-12.2,
Section 5A-12.4, or Section 5A-12.6, or Section 5A-12.7 to the
same hospitals. For the purposes of this subsection (a-5), a
hospital's payment ratio is defined as the quotient obtained by
dividing the total payments for the State fiscal year, as
authorized under Section 5A-12.2, Section 5A-12.4, or Section
5A-12.6, or Section 5A-12.7, by the total assessment for the
State fiscal year imposed under Section 5A-2 or subsection
(b-5) of Section 5A-2.
(b) The Illinois Department is authorized to establish
delayed payment schedules for hospital providers that are
unable to make installment payments when due under this Section
due to financial difficulties, as determined by the Illinois
Department.
(c) If a hospital provider fails to pay the full amount of
an installment when due (including any extensions granted under
subsection (b)), there shall, unless waived by the Illinois

SB2541 Enrolled - 48 - LRB101 18248 KTG 67690 b
Department for reasonable cause, be added to the assessment
imposed by Section 5A-2 a penalty assessment equal to the
lesser of (i) 5% of the amount of the installment not paid on
or before the due date plus 5% of the portion thereof remaining
unpaid on the last day of each 30-day period thereafter or (ii)
100% of the installment amount not paid on or before the due
date. For purposes of this subsection, payments will be
credited first to unpaid installment amounts (rather than to
penalty or interest), beginning with the most delinquent
installments.
(d) Any assessment amount that is due and payable to the
Illinois Department more frequently than once per calendar
quarter shall be remitted to the Illinois Department by the
hospital provider by means of electronic funds transfer. The
Illinois Department may provide for remittance by other means
if (i) the amount due is less than $10,000 or (ii) electronic
funds transfer is unavailable for this purpose.
(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
101-209, eff. 8-5-19.)
(305 ILCS 5/5A-8) (from Ch. 23, par. 5A-8)
Sec. 5A-8. Hospital Provider Fund.
(a) There is created in the State Treasury the Hospital
Provider Fund. Interest earned by the Fund shall be credited to
the Fund. The Fund shall not be used to replace any moneys
appropriated to the Medicaid program by the General Assembly.

SB2541 Enrolled - 49 - LRB101 18248 KTG 67690 b
(b) The Fund is created for the purpose of receiving moneys
in accordance with Section 5A-6 and disbursing moneys only for
the following purposes, notwithstanding any other provision of
law:
(1) For making payments to hospitals as required under
this Code, under the Children's Health Insurance Program
Act, under the Covering ALL KIDS Health Insurance Act, and
under the Long Term Acute Care Hospital Quality Improvement
Transfer Program Act.
(2) For the reimbursement of moneys collected by the
Illinois Department from hospitals or hospital providers
through error or mistake in performing the activities
authorized under this Code.
(3) For payment of administrative expenses incurred by
the Illinois Department or its agent in performing
activities under this Code, under the Children's Health
Insurance Program Act, under the Covering ALL KIDS Health
Insurance Act, and under the Long Term Acute Care Hospital
Quality Improvement Transfer Program Act.
(4) For payments of any amounts which are reimbursable
to the federal government for payments from this Fund which
are required to be paid by State warrant.
(5) For making transfers, as those transfers are
authorized in the proceedings authorizing debt under the
Short Term Borrowing Act, but transfers made under this
paragraph (5) shall not exceed the principal amount of debt

SB2541 Enrolled - 50 - LRB101 18248 KTG 67690 b
issued in anticipation of the receipt by the State of
moneys to be deposited into the Fund.
(6) For making transfers to any other fund in the State
treasury, but transfers made under this paragraph (6) shall
not exceed the amount transferred previously from that
other fund into the Hospital Provider Fund plus any
interest that would have been earned by that fund on the
monies that had been transferred.
(6.5) For making transfers to the Healthcare Provider
Relief Fund, except that transfers made under this
paragraph (6.5) shall not exceed $60,000,000 in the
aggregate.
(7) For making transfers not exceeding the following
amounts, related to State fiscal years 2013 through 2018,
to the following designated funds:
Health and Human Services Medicaid Trust
Fund..............................$20,000,000
Long-Term Care Provider Fund..........$30,000,000
General Revenue Fund.................$80,000,000.
Transfers under this paragraph shall be made within 7 days
after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(7.1) (Blank).
(7.5) (Blank).
(7.8) (Blank).

SB2541 Enrolled - 51 - LRB101 18248 KTG 67690 b
(7.9) (Blank).
(7.10) For State fiscal year 2014, for making transfers
of the moneys resulting from the assessment under
subsection (b-5) of Section 5A-2 and received from hospital
providers under Section 5A-4 and transferred into the
Hospital Provider Fund under Section 5A-6 to the designated
funds not exceeding the following amounts in that State
fiscal year:
Healthcare Provider Relief Fund......$100,000,000
Transfers under this paragraph shall be made within 7
days after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
The additional amount of transfers in this paragraph
(7.10), authorized by Public Act 98-651, shall be made
within 10 State business days after June 16, 2014 (the
effective date of Public Act 98-651). That authority shall
remain in effect even if Public Act 98-651 does not become
law until State fiscal year 2015.
(7.10a) For State fiscal years 2015 through 2018, for
making transfers of the moneys resulting from the
assessment under subsection (b-5) of Section 5A-2 and
received from hospital providers under Section 5A-4 and
transferred into the Hospital Provider Fund under Section
5A-6 to the designated funds not exceeding the following
amounts related to each State fiscal year:

SB2541 Enrolled - 52 - LRB101 18248 KTG 67690 b
Healthcare Provider Relief Fund......$50,000,000
Transfers under this paragraph shall be made within 7
days after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(7.11) (Blank).
(7.12) For State fiscal year 2013, for increasing by
21/365ths the transfer of the moneys resulting from the
assessment under subsection (b-5) of Section 5A-2 and
received from hospital providers under Section 5A-4 for the
portion of State fiscal year 2012 beginning June 10, 2012
through June 30, 2012 and transferred into the Hospital
Provider Fund under Section 5A-6 to the designated funds
not exceeding the following amounts in that State fiscal
year:
Healthcare Provider Relief Fund.......$2,870,000
Since the federal Centers for Medicare and Medicaid
Services approval of the assessment authorized under
subsection (b-5) of Section 5A-2, received from hospital
providers under Section 5A-4 and the payment methodologies
to hospitals required under Section 5A-12.4 was not
received by the Department until State fiscal year 2014 and
since the Department made retroactive payments during
State fiscal year 2014 related to the referenced period of
June 2012, the transfer authority granted in this paragraph
(7.12) is extended through the date that is 10 State

SB2541 Enrolled - 53 - LRB101 18248 KTG 67690 b
business days after June 16, 2014 (the effective date of
Public Act 98-651).
(7.13) In addition to any other transfers authorized
under this Section, for State fiscal years 2017 and 2018,
for making transfers to the Healthcare Provider Relief Fund
of moneys collected from the ACA Assessment Adjustment
authorized under subsections (a) and (b-5) of Section 5A-2
and paid by hospital providers under Section 5A-4 into the
Hospital Provider Fund under Section 5A-6 for each State
fiscal year. Timing of transfers to the Healthcare Provider
Relief Fund under this paragraph shall be at the discretion
of the Department, but no less frequently than quarterly.
(7.14) For making transfers not exceeding the
following amounts, related to State fiscal years 2019 and
2020 through 2024, to the following designated funds:
Health and Human Services Medicaid Trust
Fund..............................$20,000,000
Long-Term Care Provider Fund..........$30,000,000
Healthcare Health Care Provider Relief Fund
....... $325,000,000.
Transfers under this paragraph shall be made within 7
days after the payments have been received pursuant to the
schedule of payments provided in subsection (a) of Section
5A-4.
(7.15) For making transfers not exceeding the
following amounts, related to State fiscal years 2021 and

SB2541 Enrolled - 54 - LRB101 18248 KTG 67690 b
2022, to the following designated funds:
Health and Human Services Medicaid Trust
Fund..............................$20,000,000
Long-Term Care Provider Fund..........$30,000,000
Healthcare Provider Relief Fund......$365,000,000
(7.16) For making transfers not exceeding the
following amounts, related to July 1, 2022 to December 31,
2022, to the following designated funds:
Health and Human Services Medicaid Trust
Fund..............................$10,000,000
Long-Term Care Provider Fund..........$15,000,000
Healthcare Provider Relief Fund......$182,500,000
(8) For making refunds to hospital providers pursuant
to Section 5A-10.
(9) For making payment to capitated managed care
organizations as described in subsections (s) and (t) of
Section 5A-12.2, and subsection (r) of Section 5A-12.6, and
Section 5A-12.7 of this Code.
Disbursements from the Fund, other than transfers
authorized under paragraphs (5) and (6) of this subsection,
shall be by warrants drawn by the State Comptroller upon
receipt of vouchers duly executed and certified by the Illinois
Department.
(c) The Fund shall consist of the following:
(1) All moneys collected or received by the Illinois
Department from the hospital provider assessment imposed

SB2541 Enrolled - 55 - LRB101 18248 KTG 67690 b
by this Article.
(2) All federal matching funds received by the Illinois
Department as a result of expenditures made by the Illinois
Department that are attributable to moneys deposited in the
Fund.
(3) Any interest or penalty levied in conjunction with
the administration of this Article.
(3.5) As applicable, proceeds from surety bond
payments payable to the Department as referenced in
subsection (s) of Section 5A-12.2 of this Code.
(4) Moneys transferred from another fund in the State
treasury.
(5) All other moneys received for the Fund from any
other source, including interest earned thereon.
(d) (Blank).
(Source: P.A. 99-78, eff. 7-20-15; 99-516, eff. 6-30-16;
99-933, eff. 1-27-17; 100-581, eff. 3-12-18; 100-863, eff.
8-14-19; revised 7-12-19.)
(305 ILCS 5/5A-10) (from Ch. 23, par. 5A-10)
Sec. 5A-10. Applicability.
(a) The assessment imposed by subsection (a) of Section
5A-2 shall cease to be imposed and the Department's obligation
to make payments shall immediately cease, and any moneys
remaining in the Fund shall be refunded to hospital providers
in proportion to the amounts paid by them, if:

SB2541 Enrolled - 56 - LRB101 18248 KTG 67690 b
(1) The payments to hospitals required under this
Article are not eligible for federal matching funds under
Title XIX or XXI of the Social Security Act;
(2) For State fiscal years 2009 through 2018, and as
provided in Section 5A-16, the Department of Healthcare and
Family Services adopts any administrative rule change to
reduce payment rates or alters any payment methodology that
reduces any payment rates made to operating hospitals under
the approved Title XIX or Title XXI State plan in effect
January 1, 2008 except for:
(A) any changes for hospitals described in
subsection (b) of Section 5A-3;
(B) any rates for payments made under this Article
V-A;
(C) any changes proposed in State plan amendment
transmittal numbers 08-01, 08-02, 08-04, 08-06, and
08-07;
(D) in relation to any admissions on or after
January 1, 2011, a modification in the methodology for
calculating outlier payments to hospitals for
exceptionally costly stays, for hospitals reimbursed
under the diagnosis-related grouping methodology in
effect on July 1, 2011; provided that the Department
shall be limited to one such modification during the
36-month period after the effective date of this
amendatory Act of the 96th General Assembly;

SB2541 Enrolled - 57 - LRB101 18248 KTG 67690 b
(E) any changes affecting hospitals authorized by
Public Act 97-689;
(F) any changes authorized by Section 14-12 of this
Code, or for any changes authorized under Section 5A-15
of this Code; or
(G) any changes authorized under Section 5-5b.1.
(b) The assessment imposed by Section 5A-2 shall not take
effect or shall cease to be imposed, and the Department's
obligation to make payments shall immediately cease, if the
assessment is determined to be an impermissible tax under Title
XIX of the Social Security Act. Moneys in the Hospital Provider
Fund derived from assessments imposed prior thereto shall be
disbursed in accordance with Section 5A-8 to the extent federal
financial participation is not reduced due to the
impermissibility of the assessments, and any remaining moneys
shall be refunded to hospital providers in proportion to the
amounts paid by them.
(c) The assessments imposed by subsection (b-5) of Section
5A-2 shall not take effect or shall cease to be imposed, the
Department's obligation to make payments shall immediately
cease, and any moneys remaining in the Fund shall be refunded
to hospital providers in proportion to the amounts paid by
them, if the payments to hospitals required under Section
5A-12.4 or Section 5A-12.6 are not eligible for federal
matching funds under Title XIX of the Social Security Act.
(d) The assessments imposed by Section 5A-2 shall not take

SB2541 Enrolled - 58 - LRB101 18248 KTG 67690 b
effect or shall cease to be imposed, the Department's
obligation to make payments shall immediately cease, and any
moneys remaining in the Fund shall be refunded to hospital
providers in proportion to the amounts paid by them, if:
(1) for State fiscal years 2013 through 2018, and as
provided in Section 5A-16, the Department reduces any
payment rates to hospitals as in effect on May 1, 2012, or
alters any payment methodology as in effect on May 1, 2012,
that has the effect of reducing payment rates to hospitals,
except for any changes affecting hospitals authorized in
Public Act 97-689 and any changes authorized by Section
14-12 of this Code, and except for any changes authorized
under Section 5A-15, and except for any changes authorized
under Section 5-5b.1;
(2) for State fiscal years 2013 through 2018, and as
provided in Section 5A-16, the Department reduces any
supplemental payments made to hospitals below the amounts
paid for services provided in State fiscal year 2011 as
implemented by administrative rules adopted and in effect
on or prior to June 30, 2011, except for any changes
affecting hospitals authorized in Public Act 97-689 and any
changes authorized by Section 14-12 of this Code, and
except for any changes authorized under Section 5A-15, and
except for any changes authorized under Section 5-5b.1; or
(3) for State fiscal years 2015 through 2018, and as
provided in Section 5A-16, the Department reduces the

SB2541 Enrolled - 59 - LRB101 18248 KTG 67690 b
overall effective rate of reimbursement to hospitals below
the level authorized under Section 14-12 of this Code,
except for any changes under Section 14-12 or Section 5A-15
of this Code, and except for any changes authorized under
Section 5-5b.1.
(e) In Beginning in State fiscal year 2019 through State
fiscal year 2020, the assessments imposed under Section 5A-2
shall not take effect or shall cease to be imposed, the
Department's obligation to make payments shall immediately
cease, and any moneys remaining in the Fund shall be refunded
to hospital providers in proportion to the amounts paid by
them, if:
(1) the payments to hospitals required under Section
5A–12.6 are not eligible for federal matching funds under
Title XIX of the Social Security Act; or
(2) the Department reduces the overall effective rate
of reimbursement to hospitals below the level authorized
under Section 14-12 of this Code, as in effect on December
31, 2017, except for any changes authorized under Sections
14-12 or Section 5A-15 of this Code, and except for any
changes authorized under changes to Sections 5A-12.2,
5A-12.4, 5A-12.5, 5A-12.6, and 14-12 made by Public Act
100-581 this amendatory Act of the 100th General Assembly.
(f) Beginning in State Fiscal Year 2021, the assessments
imposed under Section 5A-2 shall not take effect or shall cease
to be imposed, the Department's obligation to make payments

SB2541 Enrolled - 60 - LRB101 18248 KTG 67690 b
shall immediately cease, and any moneys remaining in the Fund
shall be refunded to hospital providers in proportion to the
amounts paid by them, if:
(1) the payments to hospitals required under Section
5A-12.7 are not eligible for federal matching funds under
Title XIX of the Social Security Act; or
(2) the Department reduces the overall effective rate
of reimbursement to hospitals below the level authorized
under Section 14-12, as in effect on December 31, 2019,
except for any changes authorized under Sections 14-12 or
5A-15, and except for any changes authorized under changes
to Sections 5A-12.7 and 14-12 made by this amendatory Act
of the 101st General Assembly.
(Source: P.A. 99-2, eff. 3-26-15; 100-581, eff. 3-12-18.)
(305 ILCS 5/5A-12.7 new)
Sec. 5A-12.7. Continuation of hospital access payments on
and after July 1, 2020.
(a) To preserve and improve access to hospital services,
for hospital services rendered on and after July 1, 2020, the
Department shall, except for hospitals described in subsection
(b) of Section 5A-3, make payments to hospitals or require
capitated managed care organizations to make payments as set
forth in this Section. Payments under this Section are not due
and payable, however, until: (i) the methodologies described in
this Section are approved by the federal government in an

SB2541 Enrolled - 61 - LRB101 18248 KTG 67690 b
appropriate State Plan amendment or directed payment preprint;
and (ii) the assessment imposed under this Article is
determined to be a permissible tax under Title XIX of the
Social Security Act. In determining the hospital access
payments authorized under subsection (g) of this Section, if a
hospital ceases to qualify for payments from the pool, the
payments for all hospitals continuing to qualify for payments
from such pool shall be uniformly adjusted to fully expend the
aggregate net amount of the pool, with such adjustment being
effective on the first day of the second month following the
date the hospital ceases to receive payments from such pool.
(b) Amounts moved into claims-based rates and distributed
in accordance with Section 14-12 shall remain in those
claims-based rates.
(c) Graduate medical education.
(1) The calculation of graduate medical education
payments shall be based on the hospital's Medicare cost
report ending in Calendar Year 2018, as reported in the
Healthcare Cost Report Information System file, release
date September 30, 2019. An Illinois hospital reporting
intern and resident cost on its Medicare cost report shall
be eligible for graduate medical education payments.
(2) Each hospital's annualized Medicaid Intern
Resident Cost is calculated using annualized intern and
resident total costs obtained from Worksheet B Part I,
Columns 21 and 22 the sum of Lines 30-43, 50-76, 90-93,

SB2541 Enrolled - 62 - LRB101 18248 KTG 67690 b
96-98, and 105-112 multiplied by the percentage that the
hospital's Medicaid days (Worksheet S3 Part I, Column 7,
Lines 2, 3, 4, 14, 16-18, and 32) comprise of the
hospital's total days (Worksheet S3 Part I, Column 8, Lines
14, 16-18, and 32).
(3) An annualized Medicaid indirect medical education
(IME) payment is calculated for each hospital using its IME
payments (Worksheet E Part A, Line 29, Column 1) multiplied
by the percentage that its Medicaid days (Worksheet S3 Part
I, Column 7, Lines 2, 3, 4, 14, 16-18, and 32) comprise of
its Medicare days (Worksheet S3 Part I, Column 6, Lines 2,
3, 4, 14, and 16-18).
(4) For each hospital, its annualized Medicaid Intern
Resident Cost and its annualized Medicaid IME payment are
summed, and, except as capped at 120% of the average cost
per intern and resident for all qualifying hospitals as
calculated under this paragraph, is multiplied by 22.6% to
determine the hospital's final graduate medical education
payment. Each hospital's average cost per intern and
resident shall be calculated by summing its total
annualized Medicaid Intern Resident Cost plus its
annualized Medicaid IME payment and dividing that amount by
the hospital's total Full Time Equivalent Residents and
Interns. If the hospital's average per intern and resident
cost is greater than 120% of the same calculation for all
qualifying hospitals, the hospital's per intern and

SB2541 Enrolled - 63 - LRB101 18248 KTG 67690 b
resident cost shall be capped at 120% of the average cost
for all qualifying hospitals.
(d) Fee-for-service supplemental payments. Each Illinois
hospital shall receive an annual payment equal to the amounts
below, to be paid in 12 equal installments on or before the
seventh State business day of each month, except that no
payment shall be due within 30 days after the later of the date
of notification of federal approval of the payment
methodologies required under this Section or any waiver
required under 42 CFR 433.68, at which time the sum of amounts
required under this Section prior to the date of notification
is due and payable.
(1) For critical access hospitals, $385 per covered
inpatient day contained in paid fee-for-service claims and
$530 per paid fee-for-service outpatient claim for dates of
service in Calendar Year 2019 in the Department's
Enterprise Data Warehouse as of May 11, 2020.
(2) For safety-net hospitals, $960 per covered
inpatient day contained in paid fee-for-service claims and
$625 per paid fee-for-service outpatient claim for dates of
service in Calendar Year 2019 in the Department's
Enterprise Data Warehouse as of May 11, 2020.
(3) For long term acute care hospitals, $295 per
covered inpatient day contained in paid fee-for-service
claims for dates of service in Calendar Year 2019 in the
Department's Enterprise Data Warehouse as of May 11, 2020.

SB2541 Enrolled - 64 - LRB101 18248 KTG 67690 b
(4) For freestanding psychiatric hospitals, $125 per
covered inpatient day contained in paid fee-for-service
claims and $130 per paid fee-for-service outpatient claim
for dates of service in Calendar Year 2019 in the
Department's Enterprise Data Warehouse as of May 11, 2020.
(5) For freestanding rehabilitation hospitals, $355
per covered inpatient day contained in paid
fee-for-service claims for dates of service in Calendar
Year 2019 in the Department's Enterprise Data Warehouse as
of May 11, 2020.
(6) For all general acute care hospitals and high
Medicaid hospitals as defined in subsection (f), $350 per
covered inpatient day for dates of service in Calendar Year
2019 contained in paid fee-for-service claims and $620 per
paid fee-for-service outpatient claim in the Department's
Enterprise Data Warehouse as of May 11, 2020.
(7) Alzheimer's treatment access payment. Each
Illinois academic medical center or teaching hospital, as
defined in Section 5-5e.2 of this Code, that is identified
as the primary hospital affiliate of one of the Regional
Alzheimer's Disease Assistance Centers, as designated by
the Alzheimer's Disease Assistance Act and identified in
the Department of Public Health's Alzheimer's Disease
State Plan dated December 2016, shall be paid an
Alzheimer's treatment access payment equal to the product
of the qualifying hospital's State Fiscal Year 2018 total

SB2541 Enrolled - 65 - LRB101 18248 KTG 67690 b
inpatient fee-for-service days multiplied by the
applicable Alzheimer's treatment rate of $226.30 for
hospitals located in Cook County and $116.21 for hospitals
located outside Cook County.
(e) The Department shall require managed care
organizations (MCOs) to make directed payments and
pass-through payments according to this Section. Each calendar
year, the Department shall require MCOs to pay the maximum
amount out of these funds as allowed as pass-through payments
under federal regulations. The Department shall require MCOs to
make such pass-through payments as specified in this Section.
The Department shall require the MCOs to pay the remaining
amounts as directed Payments as specified in this Section. The
Department shall issue payments to the Comptroller by the
seventh business day of each month for all MCOs that are
sufficient for MCOs to make the directed payments and
pass-through payments according to this Section. The
Department shall require the MCOs to make pass-through payments
and directed payments using electronic funds transfers (EFT),
if the hospital provides the information necessary to process
such EFTs, in accordance with directions provided monthly by
the Department, within 7 business days of the date the funds
are paid to the MCOs, as indicated by the "Paid Date" on the
website of the Office of the Comptroller if the funds are paid
by EFT and the MCOs have received directed payment
instructions. If funds are not paid through the Comptroller by

SB2541 Enrolled - 66 - LRB101 18248 KTG 67690 b
EFT, payment must be made within 7 business days of the date
actually received by the MCO. The MCO will be considered to
have paid the pass-through payments when the payment remittance
number is generated or the date the MCO sends the check to the
hospital, if EFT information is not supplied. If an MCO is late
in paying a pass-through payment or directed payment as
required under this Section (including any extensions granted
by the Department), it shall pay a penalty, unless waived by
the Department for reasonable cause, to the Department equal to
5% of the amount of the pass-through payment or directed
payment not paid on or before the due date plus 5% of the
portion thereof remaining unpaid on the last day of each 30-day
period thereafter. Payments to MCOs that would be paid
consistent with actuarial certification and enrollment in the
absence of the increased capitation payments under this Section
shall not be reduced as a consequence of payments made under
this subsection. The Department shall publish and maintain on
its website for a period of no less than 8 calendar quarters,
the quarterly calculation of directed payments and
pass-through payments owed to each hospital from each MCO. All
calculations and reports shall be posted no later than the
first day of the quarter for which the payments are to be
issued.
(f)(1) For purposes of allocating the funds included in
capitation payments to MCOs, Illinois hospitals shall be
divided into the following classes as defined in administrative

SB2541 Enrolled - 67 - LRB101 18248 KTG 67690 b
rules:
(A) Critical access hospitals.
(B) Safety-net hospitals, except that stand-alone
children's hospitals that are not specialty children's
hospitals will not be included.
(C) Long term acute care hospitals.
(D) Freestanding psychiatric hospitals.
(E) Freestanding rehabilitation hospitals.
(F) High Medicaid hospitals. As used in this Section,
"high Medicaid hospital" means a general acute care
hospital that is not a safety-net hospital or critical
access hospital and that has a Medicaid Inpatient
Utilization Rate above 30% or a hospital that had over
35,000 inpatient Medicaid days during the applicable
period. For the period July 1, 2020 through December 31,
2020, the applicable period for the Medicaid Inpatient
Utilization Rate (MIUR) is the rate year 2020 MIUR and for
the number of inpatient days it is State fiscal year 2018.
Beginning in calendar year 2021, the Department shall use
the most recently determined MIUR, as defined in subsection
(h) of Section 5-5.02, and for the inpatient day threshold,
the State fiscal year ending 18 months prior to the
beginning of the calendar year. For purposes of calculating
MIUR under this Section, children's hospitals and
affiliated general acute care hospitals shall be
considered a single hospital.

SB2541 Enrolled - 68 - LRB101 18248 KTG 67690 b
(G) General acute care hospitals. As used under this
Section, "general acute care hospitals" means all other
Illinois hospitals not identified in subparagraphs (A)
through (F).
(2) Hospitals' qualification for each class shall be
assessed prior to the beginning of each calendar year and the
new class designation shall be effective January 1 of the next
year. The Department shall publish by rule the process for
establishing class determination.
(g) Fixed pool directed payments. Beginning July 1, 2020,
the Department shall issue payments to MCOs which shall be used
to issue directed payments to qualified Illinois safety-net
hospitals and critical access hospitals on a monthly basis in
accordance with this subsection. Prior to the beginning of each
Payout Quarter beginning July 1, 2020, the Department shall use
encounter claims data from the Determination Quarter, accepted
by the Department's Medicaid Management Information System for
inpatient and outpatient services rendered by safety-net
hospitals and critical access hospitals to determine a
quarterly uniform per unit add-on for each hospital class.
(1) Inpatient per unit add-on. A quarterly uniform per
diem add-on shall be derived by dividing the quarterly
Inpatient Directed Payments Pool amount allocated to the
applicable hospital class by the total inpatient days
contained on all encounter claims received during the
Determination Quarter, for all hospitals in the class.

SB2541 Enrolled - 69 - LRB101 18248 KTG 67690 b
(A) Each hospital in the class shall have a
quarterly inpatient directed payment calculated that
is equal to the product of the number of inpatient days
attributable to the hospital used in the calculation of
the quarterly uniform class per diem add-on,
multiplied by the calculated applicable quarterly
uniform class per diem add-on of the hospital class.
(B) Each hospital shall be paid 1/3 of its
quarterly inpatient directed payment in each of the 3
months of the Payout Quarter, in accordance with
directions provided to each MCO by the Department.
(2) Outpatient per unit add-on. A quarterly uniform per
claim add-on shall be derived by dividing the quarterly
Outpatient Directed Payments Pool amount allocated to the
applicable hospital class by the total outpatient
encounter claims received during the Determination
Quarter, for all hospitals in the class.
(A) Each hospital in the class shall have a
quarterly outpatient directed payment calculated that
is equal to the product of the number of outpatient
encounter claims attributable to the hospital used in
the calculation of the quarterly uniform class per
claim add-on, multiplied by the calculated applicable
quarterly uniform class per claim add-on of the
hospital class.
(B) Each hospital shall be paid 1/3 of its

SB2541 Enrolled - 70 - LRB101 18248 KTG 67690 b
quarterly outpatient directed payment in each of the 3
months of the Payout Quarter, in accordance with
directions provided to each MCO by the Department.
(3) Each MCO shall pay each hospital the Monthly
Directed Payment as identified by the Department on its
quarterly determination report.
(4) Definitions. As used in this subsection:
(A) "Payout Quarter" means each 3 month calendar
quarter, beginning July 1, 2020.
(B) "Determination Quarter" means each 3 month
calendar quarter, which ends 3 months prior to the
first day of each Payout Quarter.
(5) For the period July 1, 2020 through December 2020,
the following amounts shall be allocated to the following
hospital class directed payment pools for the quarterly
development of a uniform per unit add-on:
(A) $2,894,500 for hospital inpatient services for
critical access hospitals.
(B) $4,294,374 for hospital outpatient services
for critical access hospitals.
(C) $29,109,330 for hospital inpatient services
for safety-net hospitals.
(D) $35,041,218 for hospital outpatient services
for safety-net hospitals.
(h) Fixed rate directed payments. Effective July 1, 2020,
the Department shall issue payments to MCOs which shall be used

SB2541 Enrolled - 71 - LRB101 18248 KTG 67690 b
to issue directed payments to Illinois hospitals not identified
in paragraph (g) on a monthly basis. Prior to the beginning of
each Payout Quarter beginning July 1, 2020, the Department
shall use encounter claims data from the Determination Quarter,
accepted by the Department's Medicaid Management Information
System for inpatient and outpatient services rendered by
hospitals in each hospital class identified in paragraph (f)
and not identified in paragraph (g). For the period July 1,
2020 through December 2020, the Department shall direct MCOs to
make payments as follows:
(1) For general acute care hospitals an amount equal to
$1,750 multiplied by the hospital's category of service 20
case mix index for the determination quarter multiplied by
the hospital's total number of inpatient admissions for
category of service 20 for the determination quarter.
(2) For general acute care hospitals an amount equal to
$160 multiplied by the hospital's category of service 21
case mix index for the determination quarter multiplied by
the hospital's total number of inpatient admissions for
category of service 21 for the determination quarter.
(3) For general acute care hospitals an amount equal to
$80 multiplied by the hospital's category of service 22
case mix index for the determination quarter multiplied by
the hospital's total number of inpatient admissions for
category of service 22 for the determination quarter.
(4) For general acute care hospitals an amount equal to

SB2541 Enrolled - 72 - LRB101 18248 KTG 67690 b
$375 multiplied by the hospital's category of service 24
case mix index for the determination quarter multiplied by
the hospital's total number of category of service 24 paid
EAPG (EAPGs) for the determination quarter.
(5) For general acute care hospitals an amount equal to
$240 multiplied by the hospital's category of service 27
and 28 case mix index for the determination quarter
multiplied by the hospital's total number of category of
service 27 and 28 paid EAPGs for the determination quarter.
(6) For general acute care hospitals an amount equal to
$290 multiplied by the hospital's category of service 29
case mix index for the determination quarter multiplied by
the hospital's total number of category of service 29 paid
EAPGs for the determination quarter.
(7) For high Medicaid hospitals an amount equal to
$1,800 multiplied by the hospital's category of service 20
case mix index for the determination quarter multiplied by
the hospital's total number of inpatient admissions for
category of service 20 for the determination quarter.
(8) For high Medicaid hospitals an amount equal to $160
multiplied by the hospital's category of service 21 case
mix index for the determination quarter multiplied by the
hospital's total number of inpatient admissions for
category of service 21 for the determination quarter.
(9) For high Medicaid hospitals an amount equal to $80
multiplied by the hospital's category of service 22 case

SB2541 Enrolled - 73 - LRB101 18248 KTG 67690 b
mix index for the determination quarter multiplied by the
hospital's total number of inpatient admissions for
category of service 22 for the determination quarter.
(10) For high Medicaid hospitals an amount equal to
$400 multiplied by the hospital's category of service 24
case mix index for the determination quarter multiplied by
the hospital's total number of category of service 24 paid
EAPG outpatient claims for the determination quarter.
(11) For high Medicaid hospitals an amount equal to
$240 multiplied by the hospital's category of service 27
and 28 case mix index for the determination quarter
multiplied by the hospital's total number of category of
service 27 and 28 paid EAPGs for the determination quarter.
(12) For high Medicaid hospitals an amount equal to
$290 multiplied by the hospital's category of service 29
case mix index for the determination quarter multiplied by
the hospital's total number of category of service 29 paid
EAPGs for the determination quarter.
(13) For long term acute care hospitals the amount of
$495 multiplied by the hospital's total number of inpatient
days for the determination quarter.
(14) For psychiatric hospitals the amount of $210
multiplied by the hospital's total number of inpatient days
for category of service 21 for the determination quarter.
(15) For psychiatric hospitals the amount of $250
multiplied by the hospital's total number of outpatient

SB2541 Enrolled - 74 - LRB101 18248 KTG 67690 b
claims for category of service 27 and 28 for the
determination quarter.
(16) For rehabilitation hospitals the amount of $410
multiplied by the hospital's total number of inpatient days
for category of service 22 for the determination quarter.
(17) For rehabilitation hospitals the amount of $100
multiplied by the hospital's total number of outpatient
claims for category of service 29 for the determination
quarter.
(18) Each hospital shall be paid 1/3 of their quarterly
inpatient and outpatient directed payment in each of the 3
months of the Payout Quarter, in accordance with directions
provided to each MCO by the Department.
(19) Each MCO shall pay each hospital the Monthly
Directed Payment amount as identified by the Department on
its quarterly determination report.
Notwithstanding any other provision of this subsection, if
the Department determines that the actual total hospital
utilization data that is used to calculate the fixed rate
directed payments is substantially different than anticipated
when the rates in this subsection were initially determined
(for unforeseeable circumstances such as the COVID-19
pandemic), the Department may adjust the rates specified in
this subsection so that the total directed payments approximate
the total spending amount anticipated when the rates were
initially established.

SB2541 Enrolled - 75 - LRB101 18248 KTG 67690 b
Definitions. As used in this subsection:
(A) "Payout Quarter" means each calendar quarter,
beginning July 1, 2020.
(B) "Determination Quarter" means each calendar
quarter which ends 3 months prior to the first day of
each Payout Quarter.
(C) "Case mix index" means a hospital specific
calculation. For inpatient claims the case mix index is
calculated each quarter by summing the relative weight
of all inpatient Diagnosis-Related Group (DRG) claims
for a category of service in the applicable
Determination Quarter and dividing the sum by the
number of sum total of all inpatient DRG admissions for
the category of service for the associated claims. The
case mix index for outpatient claims is calculated each
quarter by summing the relative weight of all paid
EAPGs in the applicable Determination Quarter and
dividing the sum by the sum total of paid EAPGs for the
associated claims.
(i) Beginning January 1, 2021, the rates for directed
payments shall be recalculated in order to spend the additional
funds for directed payments that result from reduction in the
amount of pass-through payments allowed under federal
regulations. The additional funds for directed payments shall
be allocated proportionally to each class of hospitals based on
that class' proportion of services.

SB2541 Enrolled - 76 - LRB101 18248 KTG 67690 b
(j) Pass-through payments.
(1) For the period July 1, 2020 through December 31,
2020, the Department shall assign quarterly pass-through
payments to each class of hospitals equal to one-fourth of
the following annual allocations:
(A) $390,487,095 to safety-net hospitals.
(B) $62,553,886 to critical access hospitals.
(C) $345,021,438 to high Medicaid hospitals.
(D) $551,429,071 to general acute care hospitals.
(E) $27,283,870 to long term acute care hospitals.
(F) $40,825,444 to freestanding psychiatric
hospitals.
(G) $9,652,108 to freestanding rehabilitation
hospitals.
(2) The pass-through payments shall at a minimum ensure
hospitals receive a total amount of monthly payments under
this Section as received in calendar year 2019 in
accordance with this Article and paragraph (1) of
subsection (d-5) of Section 14-12, exclusive of amounts
received through payments referenced in subsection (b).
(3) For the calendar year beginning January 1, 2021,
and each calendar year thereafter, each hospital's
pass-through payment amount shall be reduced
proportionally to the reduction of all pass-through
payments required by federal regulations.
(k) At least 30 days prior to each calendar year, the

SB2541 Enrolled - 77 - LRB101 18248 KTG 67690 b
Department shall notify each hospital of changes to the payment
methodologies in this Section, including, but not limited to,
changes in the fixed rate directed payment rates, the aggregate
pass-through payment amount for all hospitals, and the
hospital's pass-through payment amount for the upcoming
calendar year.
(l) Notwithstanding any other provisions of this Section,
the Department may adopt rules to change the methodology for
directed and pass-through payments as set forth in this
Section, but only to the extent necessary to obtain federal
approval of a necessary State Plan amendment or Directed
Payment Preprint or to otherwise conform to federal law or
federal regulation.
(m) As used in this subsection, "managed care organization"
or "MCO" means an entity which contracts with the Department to
provide services where payment for medical services is made on
a capitated basis, excluding contracted entities for dual
eligible or Department of Children and Family Services youth
populations.
(305 ILCS 5/5A-12.8 new)
Sec. 5A-12.8. Report to the General Assembly. In order to
facilitate transparency, accountability, and future policy
development by the General Assembly, the Department shall
provide the reports and information specified in this Section.
By February 1, 2022, the Department shall provide a report to

SB2541 Enrolled - 78 - LRB101 18248 KTG 67690 b
the General Assembly that includes, but is not limited to, the
following:
(1) information on the total payments made under
Section 5A-12.7 through December 1, 2021 broken out by
payment type; and
(2) after consulting the hospital community and other
interested parties, information that summarizes and
identifies options and stakeholder suggestions on the
following:
(A) policies and practices to improve access to
care, improve health, and reduce health disparities in
vulnerable communities;
(B) analysis of charity care by hospital;
(C) revisions to the payment methodology for
graduate medical education;
(D) revisions to the directed payment
methodologies, including the opportunity for hospitals
to shift from the fixed pool to the fixed rate directed
payments;
(E) the definitions of and criteria to qualify as a
safety-net hospital, a high Medicaid hospital, or a
children's hospital; and
(F) options to revise the methodology for
calculating the assessment under Section 5A-2.
(305 ILCS 5/5A-13)

SB2541 Enrolled - 79 - LRB101 18248 KTG 67690 b
Sec. 5A-13. Emergency rulemaking.
(a) The Department of Healthcare and Family Services
(formerly Department of Public Aid) may adopt rules necessary
to implement this amendatory Act of the 94th General Assembly
through the use of emergency rulemaking in accordance with
Section 5-45 of the Illinois Administrative Procedure Act. For
purposes of that Act, the General Assembly finds that the
adoption of rules to implement this amendatory Act of the 94th
General Assembly is deemed an emergency and necessary for the
public interest, safety, and welfare.
(b) The Department of Healthcare and Family Services may
adopt rules necessary to implement this amendatory Act of the
97th General Assembly through the use of emergency rulemaking
in accordance with Section 5-45 of the Illinois Administrative
Procedure Act. For purposes of that Act, the General Assembly
finds that the adoption of rules to implement this amendatory
Act of the 97th General Assembly is deemed an emergency and
necessary for the public interest, safety, and welfare.
(c) The Department of Healthcare and Family Services may
adopt rules necessary to initially implement the changes to
Articles 5, 5A, 12, and 14 of this Code under this amendatory
Act of the 100th General Assembly through the use of emergency
rulemaking in accordance with subsection (aa) of Section 5-45
of the Illinois Administrative Procedure Act. For purposes of
that Act, the General Assembly finds that the adoption of rules
to implement the changes to Articles 5, 5A, 12, and 14 of this

SB2541 Enrolled - 80 - LRB101 18248 KTG 67690 b
Code under this amendatory Act of the 100th General Assembly is
deemed an emergency and necessary for the public interest,
safety, and welfare. The 24-month limitation on the adoption of
emergency rules does not apply to rules adopted to initially
implement the changes to Articles 5, 5A, 12, and 14 of this
Code under this amendatory Act of the 100th General Assembly.
For purposes of this subsection, "initially" means any
emergency rules necessary to immediately implement the changes
authorized to Articles 5, 5A, 12, and 14 of this Code under
this amendatory Act of the 100th General Assembly; however,
emergency rulemaking authority shall not be used to make
changes that could otherwise be made following the process
established in the Illinois Administrative Procedure Act.
(d) The Department of Healthcare and Family Services may on
a one-time-only basis adopt rules necessary to initially
implement the changes to Articles 5A and 14 of this Code under
this amendatory Act of the 100th General Assembly through the
use of emergency rulemaking in accordance with subsection (ee)
of Section 5-45 of the Illinois Administrative Procedure Act.
For purposes of that Act, the General Assembly finds that the
adoption of rules on a one-time-only basis to implement the
changes to Articles 5A and 14 of this Code under this
amendatory Act of the 100th General Assembly is deemed an
emergency and necessary for the public interest, safety, and
welfare. The 24-month limitation on the adoption of emergency
rules does not apply to rules adopted to initially implement

SB2541 Enrolled - 81 - LRB101 18248 KTG 67690 b
the changes to Articles 5A and 14 of this Code under this
amendatory Act of the 100th General Assembly.
(e) The Department of Healthcare and Family Services may
adopt rules necessary to implement the changes made to Articles
5, 5A, 12, and 14 of this Code by this amendatory Act of the
101st General Assembly through the use of emergency rulemaking
in accordance with Section 5-45.1 of the Illinois
Administrative Procedure Act. The 24-month limitation on the
adoption of emergency rules does not apply to rules adopted
under this Section. The General Assembly finds that the
adoption of rules to implement the changes made to Articles 5,
5A, 12, and 14 of this Code by this amendatory Act of the 101st
General Assembly is deemed an emergency and necessary for the
public interest, safety, and welfare.
(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19.)
(305 ILCS 5/5A-14)
Sec. 5A-14. Repeal of assessments and disbursements.
(a) Section 5A-2 is repealed on December 31, 2022 July 1,
2020.
(b) Section 5A-12 is repealed on July 1, 2005.
(c) Section 5A-12.1 is repealed on July 1, 2008.
(d) Section 5A-12.2 and Section 5A-12.4 are repealed on
July 1, 2018, subject to Section 5A-16.
(e) Section 5A-12.3 is repealed on July 1, 2011.
(f) Section 5A-12.6 is repealed on July 1, 2020.

SB2541 Enrolled - 82 - LRB101 18248 KTG 67690 b
(g) Section 5A-12.7 is repealed on December 31, 2022.
(Source: P.A. 100-581, eff. 3-12-18.)
(305 ILCS 5/5A-17 new)
Sec. 5A-17. Recovery of payments; liens.
(a) As a condition of receiving payments pursuant to
subsections (d) and (k) of Section 5A-12.7 for State Fiscal
Year 2021, a for-profit general acute care hospital that ceases
to provide hospital services before July 1, 2021 and within 12
months of a change in the hospital's ownership status from
not-for-profit to investor owned, shall be obligated to pay to
the Department an amount equal to the payments received
pursuant to subsections (d) and (k) of Section 5A-12.7 since
the change in ownership status to the cessation of hospital
services. The obligated amount shall be due immediately and
must be paid to the Department within 10 days of ceasing to
provide services or pursuant to a payment plan approved by the
Department unless the hospital requests a hearing under
paragraph (d) of this Section. The obligation under this
Section shall not apply to a hospital that ceases to provide
services under circumstances that include: implementation of a
transformation project approved by the Department under
subsection (d-5) of Section 14-12; emergencies as declared by
federal, State, or local government; actions approved or
required by federal, State, or local government; actions taken
in compliance with the Illinois Health Facilities Planning Act;

SB2541 Enrolled - 83 - LRB101 18248 KTG 67690 b
or other circumstances beyond the control of the hospital
provider or for the benefit of the community previously served
by the hospital, as determined on a case-by-case basis by the
Department.
(b) The Illinois Department shall administer and enforce
this Section and collect the obligations imposed under this
Section using procedures employed in its administration of this
Code generally. The Illinois Department, its Director, and
every hospital provider subject to this Section shall have the
following powers, duties, and rights:
(1) The Illinois Department may initiate either
administrative or judicial proceedings, or both, to
enforce the provisions of this Section. Administrative
enforcement proceedings initiated hereunder shall be
governed by the Illinois Department's administrative
rules. Judicial enforcement proceedings initiated in
accordance with this Section shall be governed by the rules
of procedure applicable in the courts of this State.
(2) No proceedings for collection, refund, credit, or
other adjustment of an amount payable under this Section
shall be issued more than 3 years after the due date of the
obligation, except in the case of an extended period agreed
to in writing by the Illinois Department and the hospital
provider before the expiration of this limitation period.
(3) Any unpaid obligation under this Section shall
become a lien upon the assets of the hospital. If any

SB2541 Enrolled - 84 - LRB101 18248 KTG 67690 b
hospital provider sells or transfers the major part of any
one or more of (i) the real property and improvements, (ii)
the machinery and equipment, or (iii) the furniture or
fixtures of any hospital that is subject to the provisions
of this Section, the seller or transferor shall pay the
Illinois Department the amount of any obligation due from
it under this Section up to the date of the sale or
transfer. If the seller or transferor fails to pay any
amount due under this Section, the purchaser or transferee
of such asset shall be liable for the amount of the
obligation up to the amount of the reasonable value of the
property acquired by the purchaser or transferee. The
purchaser or transferee shall continue to be liable until
the purchaser or transferee pays the full amount of the
obligation up to the amount of the reasonable value of the
property acquired by the purchaser or transferee or until
the purchaser or transferee receives from the Illinois
Department a certificate showing that such assessment,
penalty, and interest have been paid or a certificate from
the Illinois Department showing that no amount is due from
the seller or transferor under this Section.
(c) In addition to any other remedy provided for, the
Illinois Department may collect an unpaid obligation by
withholding, as payment of the amount due, reimbursements or
other amounts otherwise payable by the Illinois Department to
the hospital provider.

SB2541 Enrolled - 85 - LRB101 18248 KTG 67690 b
(305 ILCS 5/12-4.105)
Sec. 12-4.105. Human poison control center; payment
program. Subject to funding availability resulting from
transfers made from the Hospital Provider Fund to the
Healthcare Provider Relief Fund as authorized under this Code,
for State fiscal year 2017 and State fiscal year 2018, and for
each State fiscal year thereafter in which the assessment under
Section 5A-2 is imposed, the Department of Healthcare and
Family Services shall pay to the human poison control center
designated under the Poison Control System Act an amount of not
less than $3,000,000 for each of those State fiscal years 2017
through 2020, and for State fiscal year 2021 and 2022 an amount
of not less than $3,750,000 and for the period July 1, 2022
through December 31, 2022 an amount of not less than
$1,875,000, if that the human poison control center is in
operation.
(Source: P.A. 99-516, eff. 6-30-16; 100-581, eff. 3-12-18.)
(305 ILCS 5/14-12)
Sec. 14-12. Hospital rate reform payment system. The
hospital payment system pursuant to Section 14-11 of this
Article shall be as follows:
(a) Inpatient hospital services. Effective for discharges
on and after July 1, 2014, reimbursement for inpatient general
acute care services shall utilize the All Patient Refined

SB2541 Enrolled - 86 - LRB101 18248 KTG 67690 b
Diagnosis Related Grouping (APR-DRG) software, version 30,
distributed by 3MTM Health Information System.
(1) The Department shall establish Medicaid weighting
factors to be used in the reimbursement system established
under this subsection. Initial weighting factors shall be
the weighting factors as published by 3M Health Information
System, associated with Version 30.0 adjusted for the
Illinois experience.
(2) The Department shall establish a
statewide-standardized amount to be used in the inpatient
reimbursement system. The Department shall publish these
amounts on its website no later than 10 calendar days prior
to their effective date.
(3) In addition to the statewide-standardized amount,
the Department shall develop adjusters to adjust the rate
of reimbursement for critical Medicaid providers or
services for trauma, transplantation services, perinatal
care, and Graduate Medical Education (GME).
(4) The Department shall develop add-on payments to
account for exceptionally costly inpatient stays,
consistent with Medicare outlier principles. Outlier fixed
loss thresholds may be updated to control for excessive
growth in outlier payments no more frequently than on an
annual basis, but at least triennially. Upon updating the
fixed loss thresholds, the Department shall be required to
update base rates within 12 months.

SB2541 Enrolled - 87 - LRB101 18248 KTG 67690 b
(5) The Department shall define those hospitals or
distinct parts of hospitals that shall be exempt from the
APR-DRG reimbursement system established under this
Section. The Department shall publish these hospitals'
inpatient rates on its website no later than 10 calendar
days prior to their effective date.
(6) Beginning July 1, 2014 and ending on June 30, 2024,
in addition to the statewide-standardized amount, the
Department shall develop an adjustor to adjust the rate of
reimbursement for safety-net hospitals defined in Section
5-5e.1 of this Code excluding pediatric hospitals.
(7) Beginning July 1, 2014 and ending on June 30, 2020,
or upon implementation of inpatient psychiatric rate
increases as described in subsection (n) of Section
5A-12.6, in addition to the statewide-standardized amount,
the Department shall develop an adjustor to adjust the rate
of reimbursement for Illinois freestanding inpatient
psychiatric hospitals that are not designated as
children's hospitals by the Department but are primarily
treating patients under the age of 21.
(7.5) (Blank). Beginning July 1, 2020, the
reimbursement for inpatient psychiatric services shall be
so that base claims projected reimbursement is increased by
an amount equal to the funds allocated in paragraph (2) of
subsection (b) of Section 5A-12.6, less the amount
allocated under paragraphs (8) and (9) of this subsection

SB2541 Enrolled - 88 - LRB101 18248 KTG 67690 b
and paragraphs (3) and (4) of subsection (b) multiplied by
13%. Beginning July 1, 2022, the reimbursement for
inpatient psychiatric services shall be so that base claims
projected reimbursement is increased by an amount equal to
the funds allocated in paragraph (3) of subsection (b) of
Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 13%. Beginning
July 1, 2024, the reimbursement for inpatient psychiatric
services shall be so that base claims projected
reimbursement is increased by an amount equal to the funds
allocated in paragraph (4) of subsection (b) of Section
5A-12.6, less the amount allocated under paragraphs (8) and
(9) of this subsection and paragraphs (3) and (4) of
subsection (b) multiplied by 13%.
(8) Beginning July 1, 2018, in addition to the
statewide-standardized amount, the Department shall adjust
the rate of reimbursement for hospitals designated by the
Department of Public Health as a Perinatal Level II or II+
center by applying the same adjustor that is applied to
Perinatal and Obstetrical care cases for Perinatal Level
III centers, as of December 31, 2017.
(9) Beginning July 1, 2018, in addition to the
statewide-standardized amount, the Department shall apply
the same adjustor that is applied to trauma cases as of
December 31, 2017 to inpatient claims to treat patients

SB2541 Enrolled - 89 - LRB101 18248 KTG 67690 b
with burns, including, but not limited to, APR-DRGs 841,
842, 843, and 844.
(10) Beginning July 1, 2018, the
statewide-standardized amount for inpatient general acute
care services shall be uniformly increased so that base
claims projected reimbursement is increased by an amount
equal to the funds allocated in paragraph (1) of subsection
(b) of Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 40%. Beginning
July 1, 2020, the statewide-standardized amount for
inpatient general acute care services shall be uniformly
increased so that base claims projected reimbursement is
increased by an amount equal to the funds allocated in
paragraph (2) of subsection (b) of Section 5A-12.6, less
the amount allocated under paragraphs (8) and (9) of this
subsection and paragraphs (3) and (4) of subsection (b)
multiplied by 40%. Beginning July 1, 2022, the
statewide-standardized amount for inpatient general acute
care services shall be uniformly increased so that base
claims projected reimbursement is increased by an amount
equal to the funds allocated in paragraph (3) of subsection
(b) of Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 40%. Beginning
July 1, 2023 the statewide-standardized amount for

SB2541 Enrolled - 90 - LRB101 18248 KTG 67690 b
inpatient general acute care services shall be uniformly
increased so that base claims projected reimbursement is
increased by an amount equal to the funds allocated in
paragraph (4) of subsection (b) of Section 5A-12.6, less
the amount allocated under paragraphs (8) and (9) of this
subsection and paragraphs (3) and (4) of subsection (b)
multiplied by 40%.
(11) Beginning July 1, 2018, the reimbursement for
inpatient rehabilitation services shall be increased by
the addition of a $96 per day add-on.
Beginning July 1, 2020, the reimbursement for
inpatient rehabilitation services shall be uniformly
increased so that the $96 per day add-on is increased by an
amount equal to the funds allocated in paragraph (2) of
subsection (b) of Section 5A-12.6, less the amount
allocated under paragraphs (8) and (9) of this subsection
and paragraphs (3) and (4) of subsection (b) multiplied by
0.9%.
Beginning July 1, 2022, the reimbursement for
inpatient rehabilitation services shall be uniformly
increased so that the $96 per day add-on as adjusted by the
July 1, 2020 increase, is increased by an amount equal to
the funds allocated in paragraph (3) of subsection (b) of
Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 0.9%.

SB2541 Enrolled - 91 - LRB101 18248 KTG 67690 b
Beginning July 1, 2023, the reimbursement for
inpatient rehabilitation services shall be uniformly
increased so that the $96 per day add-on as adjusted by the
July 1, 2022 increase, is increased by an amount equal to
the funds allocated in paragraph (4) of subsection (b) of
Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of this subsection and paragraphs
(3) and (4) of subsection (b) multiplied by 0.9%.
(b) Outpatient hospital services. Effective for dates of
service on and after July 1, 2014, reimbursement for outpatient
services shall utilize the Enhanced Ambulatory Procedure
Grouping (EAPG) software, version 3.7 distributed by 3MTM
Health Information System.
(1) The Department shall establish Medicaid weighting
factors to be used in the reimbursement system established
under this subsection. The initial weighting factors shall
be the weighting factors as published by 3M Health
Information System, associated with Version 3.7.
(2) The Department shall establish service specific
statewide-standardized amounts to be used in the
reimbursement system.
(A) The initial statewide standardized amounts,
with the labor portion adjusted by the Calendar Year
2013 Medicare Outpatient Prospective Payment System
wage index with reclassifications, shall be published
by the Department on its website no later than 10

SB2541 Enrolled - 92 - LRB101 18248 KTG 67690 b
calendar days prior to their effective date.
(B) The Department shall establish adjustments to
the statewide-standardized amounts for each Critical
Access Hospital, as designated by the Department of
Public Health in accordance with 42 CFR 485, Subpart F.
For outpatient services provided on or before June 30,
2018, the EAPG standardized amounts are determined
separately for each critical access hospital such that
simulated EAPG payments using outpatient base period
paid claim data plus payments under Section 5A-12.4 of
this Code net of the associated tax costs are equal to
the estimated costs of outpatient base period claims
data with a rate year cost inflation factor applied.
(3) In addition to the statewide-standardized amounts,
the Department shall develop adjusters to adjust the rate
of reimbursement for critical Medicaid hospital outpatient
providers or services, including outpatient high volume or
safety-net hospitals. Beginning July 1, 2018, the
outpatient high volume adjustor shall be increased to
increase annual expenditures associated with this adjustor
by $79,200,000, based on the State Fiscal Year 2015 base
year data and this adjustor shall apply to public
hospitals, except for large public hospitals, as defined
under 89 Ill. Adm. Code 148.25(a).
(4) Beginning July 1, 2018, in addition to the
statewide standardized amounts, the Department shall make

SB2541 Enrolled - 93 - LRB101 18248 KTG 67690 b
an add-on payment for outpatient expensive devices and
drugs. This add-on payment shall at least apply to claim
lines that: (i) are assigned with one of the following
EAPGs: 490, 1001 to 1020, and coded with one of the
following revenue codes: 0274 to 0276, 0278; or (ii) are
assigned with one of the following EAPGs: 430 to 441, 443,
444, 460 to 465, 495, 496, 1090. The add-on payment shall
be calculated as follows: the claim line's covered charges
multiplied by the hospital's total acute cost to charge
ratio, less the claim line's EAPG payment plus $1,000,
multiplied by 0.8.
(5) Beginning July 1, 2018, the statewide-standardized
amounts for outpatient services shall be increased by a
uniform percentage so that base claims projected
reimbursement is increased by an amount equal to no less
than the funds allocated in paragraph (1) of subsection (b)
of Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of subsection (a) and paragraphs (3)
and (4) of this subsection multiplied by 46%. Beginning
July 1, 2020, the statewide-standardized amounts for
outpatient services shall be increased by a uniform
percentage so that base claims projected reimbursement is
increased by an amount equal to no less than the funds
allocated in paragraph (2) of subsection (b) of Section
5A-12.6, less the amount allocated under paragraphs (8) and
(9) of subsection (a) and paragraphs (3) and (4) of this

SB2541 Enrolled - 94 - LRB101 18248 KTG 67690 b
subsection multiplied by 46%. Beginning July 1, 2022, the
statewide-standardized amounts for outpatient services
shall be increased by a uniform percentage so that base
claims projected reimbursement is increased by an amount
equal to the funds allocated in paragraph (3) of subsection
(b) of Section 5A-12.6, less the amount allocated under
paragraphs (8) and (9) of subsection (a) and paragraphs (3)
and (4) of this subsection multiplied by 46%. Beginning
July 1, 2023, the statewide-standardized amounts for
outpatient services shall be increased by a uniform
percentage so that base claims projected reimbursement is
increased by an amount equal to no less than the funds
allocated in paragraph (4) of subsection (b) of Section
5A-12.6, less the amount allocated under paragraphs (8) and
(9) of subsection (a) and paragraphs (3) and (4) of this
subsection multiplied by 46%.
(6) Effective for dates of service on or after July 1,
2018, the Department shall establish adjustments to the
statewide-standardized amounts for each Critical Access
Hospital, as designated by the Department of Public Health
in accordance with 42 CFR 485, Subpart F, such that each
Critical Access Hospital's standardized amount for
outpatient services shall be increased by the applicable
uniform percentage determined pursuant to paragraph (5) of
this subsection. It is the intent of the General Assembly
that the adjustments required under this paragraph (6) by

SB2541 Enrolled - 95 - LRB101 18248 KTG 67690 b
Public Act 100-1181 this amendatory Act of the 100th
General Assembly shall be applied retroactively to claims
for dates of service provided on or after July 1, 2018.
(7) Effective for dates of service on or after March 8,
2019 (the effective date of Public Act 100-1181) this
amendatory Act of the 100th General Assembly, the
Department shall recalculate and implement an updated
statewide-standardized amount for outpatient services
provided by hospitals that are not Critical Access
Hospitals to reflect the applicable uniform percentage
determined pursuant to paragraph (5).
(1) Any recalculation to the
statewide-standardized amounts for outpatient services
provided by hospitals that are not Critical Access
Hospitals shall be the amount necessary to achieve the
increase in the statewide-standardized amounts for
outpatient services increased by a uniform percentage,
so that base claims projected reimbursement is
increased by an amount equal to no less than the funds
allocated in paragraph (1) of subsection (b) of Section
5A-12.6, less the amount allocated under paragraphs
(8) and (9) of subsection (a) and paragraphs (3) and
(4) of this subsection, for all hospitals that are not
Critical Access Hospitals, multiplied by 46%.
(2) It is the intent of the General Assembly that
the recalculations required under this paragraph (7)

SB2541 Enrolled - 96 - LRB101 18248 KTG 67690 b
by Public Act 100-1181 this amendatory Act of the 100th
General Assembly shall be applied prospectively to
claims for dates of service provided on or after March
8, 2019 (the effective date of Public Act 100-1181)
this amendatory Act of the 100th General Assembly and
that no recoupment or repayment by the Department or an
MCO of payments attributable to recalculation under
this paragraph (7), issued to the hospital for dates of
service on or after July 1, 2018 and before March 8,
2019 (the effective date of Public Act 100-1181) this
amendatory Act of the 100th General Assembly, shall be
permitted.
(8) The Department shall ensure that all necessary
adjustments to the managed care organization capitation
base rates necessitated by the adjustments under
subparagraph (6) or (7) of this subsection are completed
and applied retroactively in accordance with Section
5-30.8 of this Code within 90 days of March 8, 2019 (the
effective date of Public Act 100-1181) this amendatory Act
of the 100th General Assembly.
(9) Within 60 days after federal approval of the change
made to the assessment in Section 5A-2 by this amendatory
Act of the 101st General Assembly, the Department shall
incorporate into the EAPG system for outpatient services
those services performed by hospitals currently billed
through the Non-Institutional Provider billing system.

SB2541 Enrolled - 97 - LRB101 18248 KTG 67690 b
(c) In consultation with the hospital community, the
Department is authorized to replace 89 Ill. Admin. Code 152.150
as published in 38 Ill. Reg. 4980 through 4986 within 12 months
of June 16, 2014 (the effective date of Public Act 98-651). If
the Department does not replace these rules within 12 months of
June 16, 2014 (the effective date of Public Act 98-651), the
rules in effect for 152.150 as published in 38 Ill. Reg. 4980
through 4986 shall remain in effect until modified by rule by
the Department. Nothing in this subsection shall be construed
to mandate that the Department file a replacement rule.
(d) Transition period. There shall be a transition period
to the reimbursement systems authorized under this Section that
shall begin on the effective date of these systems and continue
until June 30, 2018, unless extended by rule by the Department.
To help provide an orderly and predictable transition to the
new reimbursement systems and to preserve and enhance access to
the hospital services during this transition, the Department
shall allocate a transitional hospital access pool of at least
$290,000,000 annually so that transitional hospital access
payments are made to hospitals.
(1) After the transition period, the Department may
begin incorporating the transitional hospital access pool
into the base rate structure; however, the transitional
hospital access payments in effect on June 30, 2018 shall
continue to be paid, if continued under Section 5A-16.
(2) After the transition period, if the Department

SB2541 Enrolled - 98 - LRB101 18248 KTG 67690 b
reduces payments from the transitional hospital access
pool, it shall increase base rates, develop new adjustors,
adjust current adjustors, develop new hospital access
payments based on updated information, or any combination
thereof by an amount equal to the decreases proposed in the
transitional hospital access pool payments, ensuring that
the entire transitional hospital access pool amount shall
continue to be used for hospital payments.
(d-5) Hospital and health care transformation program. The
Department, in conjunction with the Hospital Transformation
Review Committee created under subsection (d-5), shall develop
a hospital and health care transformation program to provide
financial assistance to hospitals in transforming their
services and care models to better align with the needs of the
communities they serve. The payments authorized in this Section
shall be subject to approval by the federal government.
(1) Phase 1. In State fiscal years 2019 through 2020,
the Department shall allocate funds from the transitional
access hospital pool to create a hospital transformation
pool of at least $262,906,870 annually and make hospital
transformation payments to hospitals. Subject to Section
5A-16, in State fiscal years 2019 and 2020, an Illinois
hospital that received either a transitional hospital
access payment under subsection (d) or a supplemental
payment under subsection (f) of this Section in State
fiscal year 2018, shall receive a hospital transformation

SB2541 Enrolled - 99 - LRB101 18248 KTG 67690 b
payment as follows:
(A) If the hospital's Rate Year 2017 Medicaid
inpatient utilization rate is equal to or greater than
45%, the hospital transformation payment shall be
equal to 100% of the sum of its transitional hospital
access payment authorized under subsection (d) and any
supplemental payment authorized under subsection (f).
(B) If the hospital's Rate Year 2017 Medicaid
inpatient utilization rate is equal to or greater than
25% but less than 45%, the hospital transformation
payment shall be equal to 75% of the sum of its
transitional hospital access payment authorized under
subsection (d) and any supplemental payment authorized
under subsection (f).
(C) If the hospital's Rate Year 2017 Medicaid
inpatient utilization rate is less than 25%, the
hospital transformation payment shall be equal to 50%
of the sum of its transitional hospital access payment
authorized under subsection (d) and any supplemental
payment authorized under subsection (f).
(2) Phase 2.
(A) The funding amount from phase one shall be
incorporated into directed payment and pass-through
payment methodologies described in Section 5A-12.7.
During State fiscal years 2021 and 2022, the Department
shall allocate funds from the transitional access

SB2541 Enrolled - 100 - LRB101 18248 KTG 67690 b
hospital pool to create a hospital transformation pool
annually and make hospital transformation payments to
hospitals participating in the transformation program.
Any hospital may seek transformation funding in Phase
2. Any hospital that seeks transformation funding in
Phase 2 to update or repurpose the hospital's physical
structure to transition to a new delivery model, must
submit to the Department in writing a transformation
plan, based on the Department's guidelines, that
describes the desired delivery model with projections
of patient volumes by service lines and projected
revenues, expenses, and net income that correspond to
the new delivery model. In Phase 2, subject to the
approval of rules, the Department may use the hospital
transformation pool to increase base rates, develop
new adjustors, adjust current adjustors, or develop
new access payments in order to support and incentivize
hospitals to pursue such transformation. In developing
such methodologies, the Department shall ensure that
the entire hospital transformation pool continues to
be expended to ensure access to hospital services or to
support organizations that had received hospital
transformation payments under this Section.
(B) Whereas there are communities in Illinois that
suffer from significant health care disparities
aggravated by social determinants of health and a lack

SB2541 Enrolled - 101 - LRB101 18248 KTG 67690 b
of sufficiently allocated healthcare resources,
particularly community-based services and preventive
care, there is established a new hospital and health
care transformation program, which shall be supported
by a transformation funding pool. An application for
funding from the hospital and health care
transformation program may incorporate the campus of a
hospital closed after January 1, 2018 or a hospital
that has provided notice of its intent to close
pursuant to Section 8.7 of the Illinois Health
Facilities Planning Act. During State Fiscal Years
2021 through 2023, the hospital and health care
transformation program shall be supported by an annual
transformation funding pool of at least $150,000,000
to be allocated during the specified fiscal years for
the purpose of facilitating hospital and health care
transformation. The Department shall not allocate
funds associated with the hospital and health care
transformation pool as established in this
subparagraph until the General Assembly has
established in law or resolution, further criteria for
dispersal or allocation of those funds after the
effective date of this amendatory Act of 101st General
Assembly.
(A) Any hospital participating in the hospital
transformation program shall provide an opportunity

SB2541 Enrolled - 102 - LRB101 18248 KTG 67690 b
for public input by local community groups, hospital
workers, and healthcare professionals and assist in
facilitating discussions about any transformations or
changes to the hospital.
(C) (B) As provided in paragraph (9) of Section 3
of the Illinois Health Facilities Planning Act, any
hospital participating in the transformation program
may be excluded from the requirements of the Illinois
Health Facilities Planning Act for those projects
related to the hospital's transformation. To be
eligible, the hospital must submit to the Health
Facilities and Services Review Board approval from
certification from the Department, approved by the
Hospital Transformation Review Committee, that the
project is a part of the hospital's transformation.
(D) (C) As provided in subsection (a-20) of Section
32.5 of the Emergency Medical Services (EMS) Systems
Act, a hospital that received hospital transformation
payments under this Section may convert to a
freestanding emergency center. To be eligible for such
a conversion, the hospital must submit to the
Department of Public Health approval certification
from the Department, approved by the Hospital
Transformation Review Committee, that the project is a
part of the hospital's transformation.
(3) (Blank). By April 1, 2019 March 12, 2018 (Public

SB2541 Enrolled - 103 - LRB101 18248 KTG 67690 b
Act 100-581) the Department, in conjunction with the
Hospital Transformation Review Committee, shall develop
and file as an administrative rule with the Secretary of
State the goals, objectives, policies, standards, payment
models, or criteria to be applied in Phase 2 of the program
to allocate the hospital transformation funds. The goals,
objectives, and policies to be considered may include, but
are not limited to, achieving unmet needs of a community
that a hospital serves such as behavioral health services,
outpatient services, or drug rehabilitation services;
attaining certain quality or patient safety benchmarks for
health care services; or improving the coordination,
effectiveness, and efficiency of care delivery.
Notwithstanding any other provision of law, any rule
adopted in accordance with this subsection (d-5) may be
submitted to the Joint Committee on Administrative Rules
for approval only if the rule has first been approved by 9
of the 14 members of the Hospital Transformation Review
Committee.
(4) Hospital Transformation Review Committee. There is
created the Hospital Transformation Review Committee. The
Committee shall consist of 14 members. No later than 30
days after March 12, 2018 (the effective date of Public Act
100-581), the 4 legislative leaders shall each appoint 3
members; the Governor shall appoint the Director of
Healthcare and Family Services, or his or her designee, as

SB2541 Enrolled - 104 - LRB101 18248 KTG 67690 b
a member; and the Director of Healthcare and Family
Services shall appoint one member. Any vacancy shall be
filled by the applicable appointing authority within 15
calendar days. The members of the Committee shall select a
Chair and a Vice-Chair from among its members, provided
that the Chair and Vice-Chair cannot be appointed by the
same appointing authority and must be from different
political parties. The Chair shall have the authority to
establish a meeting schedule and convene meetings of the
Committee, and the Vice-Chair shall have the authority to
convene meetings in the absence of the Chair. The Committee
may establish its own rules with respect to meeting
schedule, notice of meetings, and the disclosure of
documents; however, the Committee shall not have the power
to subpoena individuals or documents and any rules must be
approved by 9 of the 14 members. The Committee shall
perform the functions described in this Section and advise
and consult with the Director in the administration of this
Section. In addition to reviewing and approving the
policies, procedures, and rules for the hospital and health
care transformation program, the Committee shall consider
and make recommendations related to qualifying criteria
and payment methodologies related to safety-net hospitals
and children's hospitals. Members of the Committee
appointed by the legislative leaders shall be subject to
the jurisdiction of the Legislative Ethics Commission, not

SB2541 Enrolled - 105 - LRB101 18248 KTG 67690 b
the Executive Ethics Commission, and all requests under the
Freedom of Information Act shall be directed to the
applicable Freedom of Information officer for the General
Assembly. The Department shall provide operational support
to the Committee as necessary. The Committee is dissolved
on April 1, 2019.
(e) Beginning 36 months after initial implementation, the
Department shall update the reimbursement components in
subsections (a) and (b), including standardized amounts and
weighting factors, and at least triennially and no more
frequently than annually thereafter. The Department shall
publish these updates on its website no later than 30 calendar
days prior to their effective date.
(f) Continuation of supplemental payments. Any
supplemental payments authorized under Illinois Administrative
Code 148 effective January 1, 2014 and that continue during the
period of July 1, 2014 through December 31, 2014 shall remain
in effect as long as the assessment imposed by Section 5A-2
that is in effect on December 31, 2017 remains in effect.
(g) Notwithstanding subsections (a) through (f) of this
Section and notwithstanding the changes authorized under
Section 5-5b.1, any updates to the system shall not result in
any diminishment of the overall effective rates of
reimbursement as of the implementation date of the new system
(July 1, 2014). These updates shall not preclude variations in
any individual component of the system or hospital rate

SB2541 Enrolled - 106 - LRB101 18248 KTG 67690 b
variations. Nothing in this Section shall prohibit the
Department from increasing the rates of reimbursement or
developing payments to ensure access to hospital services.
Nothing in this Section shall be construed to guarantee a
minimum amount of spending in the aggregate or per hospital as
spending may be impacted by factors, including, but not limited
to, the number of individuals in the medical assistance program
and the severity of illness of the individuals.
(h) The Department shall have the authority to modify by
rulemaking any changes to the rates or methodologies in this
Section as required by the federal government to obtain federal
financial participation for expenditures made under this
Section.
(i) Except for subsections (g) and (h) of this Section, the
Department shall, pursuant to subsection (c) of Section 5-40 of
the Illinois Administrative Procedure Act, provide for
presentation at the June 2014 hearing of the Joint Committee on
Administrative Rules (JCAR) additional written notice to JCAR
of the following rules in order to commence the second notice
period for the following rules: rules published in the Illinois
Register, rule dated February 21, 2014 at 38 Ill. Reg. 4559
(Medical Payment), 4628 (Specialized Health Care Delivery
Systems), 4640 (Hospital Services), 4932 (Diagnostic Related
Grouping (DRG) Prospective Payment System (PPS)), and 4977
(Hospital Reimbursement Changes), and published in the
Illinois Register dated March 21, 2014 at 38 Ill. Reg. 6499

SB2541 Enrolled - 107 - LRB101 18248 KTG 67690 b
(Specialized Health Care Delivery Systems) and 6505 (Hospital
Services).
(j) Out-of-state hospitals. Beginning July 1, 2018, for
purposes of determining for State fiscal years 2019 and 2020
and subsequent fiscal years the hospitals eligible for the
payments authorized under subsections (a) and (b) of this
Section, the Department shall include out-of-state hospitals
that are designated a Level I pediatric trauma center or a
Level I trauma center by the Department of Public Health as of
December 1, 2017.
(k) The Department shall notify each hospital and managed
care organization, in writing, of the impact of the updates
under this Section at least 30 calendar days prior to their
effective date.
(Source: P.A. 100-581, eff. 3-12-18; 100-1181, eff. 3-8-19;
101-81, eff. 7-12-19; revised 7-29-19.)
Section 97. Severability. If any provision of this Act or
application thereof to any person or circumstance is held
invalid, such invalidity does not affect other provisions or
applications of this Act which can be given effect without the
invalid application or provision, and to this end the
provisions of this Act are declared to be severable.