Sec. 15-10. Disproportionate share hospital adjustment payments.

524 words·~2 min read·/il/chapter-305/act-5/15-10

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(a)The provisions of this Section become operative if:

(1)The federal government approves State Plan Amendment transmittal number 08-06 or a

State Plan Amendment that permits disproportionate share hospital adjustment payments to be made to county hospitals.

(2)Proposed federal regulations, or other regulations or limitations driven by the

federal government, negatively impact the net revenues realized by county providers from the Fund during a State fiscal year by more than 15%, as measured by the aggregate average net monthly payment received by the county providers from the Fund from July 2007 through May 2008.

(3)The county providers have in good faith submitted timely, complete, and accurate

cost reports and supplemental documents as required by the Illinois Department.

(4)the county providers maintain and bill for service volumes to individuals eligible

for medical assistance under this Code that are no lower than 85% of the volumes provided by and billed to the Illinois Department by the county providers associated with payments received by the county providers from July 2007 through May 2008. Given the substantial financial burdens of the county associated with uncompensated care, the Illinois Department shall make good faith efforts to work with the county to maintain Medicaid volumes to the extent that the county has the adequate capacity to meet the obligations of patient volumes.

The Illinois Department and the county shall include in an intergovernmental agreement the process by which these conditions are assessed. The parties may, if necessary, contract with a large, nationally recognized public accounting firm to carry out this function.

(b)If the conditions of subsection

(a)are met, and subject to appropriation or other available funding for such purpose, the Illinois Department shall make a payment or otherwise make funds available to the county hospitals, during the lapse period, that provides for total payments to be at least at a level that is equivalent to the total fee-for-service payments received by the county providers that are enrolled with the Illinois Department to provide services during the fiscal year of the payment from the Fund from July 2007 through May 2008 multiplied by twelve-elevenths.

(c)In addition, notwithstanding any provision in subsection (a), the Illinois Department shall maximize disproportionate share hospital adjustment payments to the county hospitals that, at a minimum, are 42% of the State's federal fiscal year 2007 disproportionate share allocation.

(d)For the purposes of this Section, "net revenues" means the difference between the total fee-for-service payments made by the Illinois Department to county providers less the intergovernmental transfer made by the county in support of those payments.

(e)If

(i)the disproportionate share hospital adjustment State Plan Amendment referenced in subdivision (a)(1) is not approved, or

(ii)any reconciliation of payments to costs incurred would require repayment to the federal government of at least $2,500,000, or

(iii)there is no funding available for the Illinois Department's obligations under subsection (b), the Illinois Department, the county, and the leadership of the General Assembly shall designate individuals to convene, within 30 days, to discuss how mutual funding goals for the county providers are to be achieved.