Sec. 5A-15. Protection of federal revenue.

474 words·~2 min read·/il/chapter-305/act-5/5a-15

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

(a)If the federal Centers for Medicare and Medicaid Services finds that any federal upper payment limit applicable to the payments under this Article is exceeded then:

(i)if such finding is made before payments have been issued, the payments under

this Article and the increases in claims-based hospital payment rates specified under Section 14-12 of this Code, as authorized under Public Act 100-581, that exceed the applicable federal upper payment limit shall be reduced uniformly to the extent necessary to comply with the applicable federal upper payment limit; or

(ii)if such finding is made after payments have been issued, the payments under this Article that exceed the applicable federal upper payment limit shall be reduced uniformly to the extent necessary to comply with the applicable federal upper payment limit; and

(2)any assessment rate imposed under this Article shall be reduced such that the

aggregate assessment is reduced by the same percentage reduction applied in paragraph (1); and

(3)any transfers from the Hospital Provider Fund under Section 5A-8 shall be reduced by

the same percentage reduction applied in paragraph (1).

(b)Any payment reductions made under the authority granted in this Section are exempt from the requirements and actions under Section 5A-10.

(c)If any payments made as a result of the requirements of this Article are subject to a disallowance, deferral, or adjustment of federal matching funds then:

(1)the Department shall recoup the payments related to those federal matching funds

paid by the Department from the parties paid by the Department;

(2)if the payments that are subject to a disallowance, deferral, or adjustment of

federal matching funds were made to MCOs, the Department shall recoup the payments related to the disallowance, deferral, or adjustment from the MCOs no sooner than the Department is required to remit federal matching funds to the Centers for Medicare and Medicaid Services or any other federal agency, and hospitals that received payments from the MCOs that were made with such disallowed, deferred, or adjusted federal matching funds must return those payments to the MCOs at least 10 business days before the MCOs are required to remit such payments to the Department; and

(3)any assessment paid to the Department by hospitals under this Article that is

attributable to the payments that are subject to a disallowance, deferral, or adjustment of federal matching funds, shall be refunded to the hospitals by the Department.

If an MCO is unable to recoup funds from a hospital for any reason, then the Department, upon written notice from an MCO, shall work in good faith with the MCO to mitigate losses associated with the lack of recoupment. Losses by an MCO shall not exceed 1% of the total payments distributed by the MCO to hospitals pursuant to the Hospital Assessment Program.