Sec. 5A-16. State fiscal year 2019 implementation protection.

825 words·~4 min read·/il/chapter-305/act-5/5a-16

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(a)To preserve access to hospital services and to ensure continuity of payments and stability of access to hospital services, it is the intent of the General Assembly that there not be a gap in payments to hospitals while the changes authorized under Public Act 100-581 are being reviewed by the federal Centers for Medicare and Medicaid Services and implemented by the Department. Therefore, pending the review and approval of the changes to the assessment and hospital reimbursement methodologies authorized under Public Act 100-581 by the federal Centers for Medicare and Medicaid Services and the final implementation of such program by the Department, the Department shall take all actions necessary to continue the reimbursement methodologies and payments to hospitals that are changed under Public Act 100-581, as they are in effect on June 30, 2018, until the first day of the second month after the new and revised methodologies and payments authorized under Public Act 100-581 are effective and implemented by the Department. Such actions by the Department shall include, but not be limited to, requesting prior to June 15, 2018 the extension of any federal approval of the currently approved payment methodologies contained in Illinois' Medicaid State Plan while the federal Centers for Medicare and Medicaid Services reviews the proposed changes authorized under Public Act 100-581.

(b)Notwithstanding any other provision of this Code, if the federal Centers for Medicare and Medicaid Services should approve the continuation of the reimbursement methodologies and payments to hospitals under Sections 5A-12.5 and 14-12, as they are in effect on June 30, 2018, until the new and revised methodologies and payments authorized under Sections 5A-12.6 and 14-12 of this Code are federally approved, then the reimbursement methodologies and payments to hospitals under Sections 5A-12.2, 5A-12.4, 5A-12.5, and 14-12, and the assessments imposed under Section 5A-2, as they are in effect on June 30, 2018, shall continue until the effective date of the new and revised methodologies and payments, which shall be the first day of the second month following the date of approval by the federal Centers for Medicare and Medicaid Services.

(c)Notwithstanding any other provision of this Code, if by July 11, 2018 the federal Centers for Medicare and Medicaid Services has neither approved the changes authorized under Public Act 100-581 nor has formally approved an extension of the reimbursement methodologies and payments to hospitals under Sections 5A-12.5 and 14-12 as they are in effect on June 30, 2018, then the following shall apply:

(1)All reimbursement methodologies and payments for hospital services authorized under

Sections 5A-12.2, 5A-12.4, and 5A-12.5 in effect on June 30, 2018 shall continue subject to the availability of federal matching funds for such expenditures and subject to the provisions of subsection

(c)of Section 5A-15.

(2)All supplemental payments to hospitals authorized in Illinois' Medicaid State Plan

in effect on June 30, 2018, which are scheduled to terminate under Illinois' Medicaid State Plan on June 30, 2018, shall continue subject to the availability of federal matching funds for such expenditures.

(3)All assessments imposed under Section 5A-2, as they are in effect on June 30, 2018,

shall continue.

(4)Notwithstanding any other provision in this subsection (c), the Department shall

make monthly advance payments to any safety-net hospital or critical access hospital requesting such advance payments in an amount, as requested by the hospital, provided that the total monthly payments to the hospital under this subsection shall not exceed 1/12th of the payments the hospital would have received under Sections 5A-12.2, 5A-12.4, and 5A-12.5 and subsections

(d)and

(f)of Section 14-12.

Notwithstanding any other provision in this subsection (c), the Department may make

monthly advance payments to a hospital requesting such advance payments in an amount, as requested by the hospital, provided that the total monthly payments to the hospital under this subsection shall not exceed 1/12th of the payments the hospital would have received under Sections 5A-12.2, 5A-12.4, and 5A-12.5 and subsections

(d)and

(f)of Section 14-12.

Advance payments under this paragraph

(4)shall be made regardless of federal approval

for federal financial participation under Title XIX or XXI of the federal Social Security Act.

As used in this paragraph (4), "safety-net hospital" means a hospital as defined in

Section 5-5e.1 for Rate Year 2017 or an Illinois hospital that meets the criteria in paragraphs

(2)and

(3)of subsection

(a)of Section 5-5e.1 for Rate Year 2017.

As used in this paragraph (4), "critical access hospital" means a hospital that has such

status as of June 30, 2018.

(5)The changes authorized under this subsection

(c)shall continue, on the same time

schedule as otherwise authorized under this Article, until the effective date of the new and revised methodologies and payments under Public Act 100-581, which shall be the first day of the second month following the date of approval by the federal Centers for Medicare and Medicaid Services.