Chapter 305, PUBLIC AID

(305 ILCS 5/5-5b) (from Ch. 23, par. 5-5b) Sec. 5-5b. Payment Reductions. (a) Notwithstanding any other Section in this Code establishing a methodology for determining payment rates or dispensing fees for non-institutional services provided under this Code, the Illinois Departmen…

(305 ILCS 5/5-5b.1) Sec. 5-5b.1. Reimbursement rates; Fiscal Year 2015 reductions. (a) Except as provided in subsection (b), notwithstanding any other provision of this Code to the contrary, and subject to rescission if not federally approved, providers of the following services …

(305 ILCS 5/5-5c) Sec. 5-5c. Waiver for home and community-based services for traumatic brain injury (TBI) patients. The Department shall apply for a waiver from the United States Health Care Financing Administration to allow payment for home and community-based services under th…

(305 ILCS 5/5-5d) Sec. 5-5d. Enhanced transition and follow-up services. The Department of Healthcare and Family Services shall apply for any necessary waivers pursuant to Section 1915(c) of the Social Security Act to facilitate the transition from one residential setting to anot…

(305 ILCS 5/5-5e) Sec. 5-5e. Adjusted rates of reimbursement. (a) Rates or payments for services in effect on June 30, 2012 shall be adjusted and services shall be affected as required by any other provision of Public Act 97-689. In addition, the Department shall do the following…

(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 1…

(305 ILCS 5/5-5e.2) Sec. 5-5e.2. Academic medical centers and major teaching hospital status. (a) Hospitals dedicated to medical research and medical education shall be classified each State fiscal year in 3 tiers based on specific criteria: (1) Tier I. A private academic medical…

(305 ILCS 5/5-5f) Sec. 5-5f. Elimination and limitations of medical assistance services. Notwithstanding any other provision of this Code to the contrary, on and after July 1, 2012: (a) The following service shall no longer be a covered service available under this Code: group ps…

(305 ILCS 5/5-5g) Sec. 5-5g. Long-term care patient; resident status. Long-term care providers shall submit all changes in resident status, including, but not limited to, death, discharge, changes in patient credit, third party liability, and Medicare coverage, to the Department …

(305 ILCS 5/5-5h) Sec. 5-5h. Long-term acute care hospital base rates. (a) The base per diem rate paid to long-term acute care hospitals for Medicaid services on and after January 1, 2020 must be $60 more than the base rate in effect on June 30, 2019. (b) Nothing in this Section …

(305 ILCS 5/5-5i) Sec. 5-5i. Rate increase for speech, physical, and occupational therapy services. Subject to federal approval, beginning January 1, 2024, the Department shall increase reimbursement rates for speech therapy services, physical therapy services, and occupational t…

(305 ILCS 5/5-5j) Sec. 5-5j. Speech-language rehabilitative and habilitative services. Subject to federal approval, for services beginning on and after July 1, 2026, the medical assistance program shall provide coverage for medically necessary rehabilitative and habilitative serv…

(305 ILCS 5/5-6) (from Ch. 23, par. 5-6) Sec. 5-6. Obligations incurred prior to death of a recipient. Obligations incurred but not paid for at the time of a recipient's death for services authorized under Section 5-5, including medical and other care in facilities as defined in …

(305 ILCS 5/5-60) Sec. 5-60. Optometric services; reimbursement rates. Notwithstanding any other law or rule to the contrary and subject to federal approval, for dates of service beginning on and after January 1, 2025, the reimbursement rates for optometric and optical services f…

(305 ILCS 5/5-61) Sec. 5-61. Advance payment reporting. Notwithstanding any provision of State law to the contrary, the Department of Healthcare and Family Services shall provide notice to the Director of the Governor's Office of Management and Budget, or the Director's designee,…

(305 ILCS 5/5-65) Sec. 5-65. Reimbursement rates for long-term electrocardiogram monitoring. (a) As used in this Section, "long-term ambulatory electrocardiogram monitoring services" means the provision of external cardiac patch monitoring devices to patients to wear for 48 hours…

(305 ILCS 5/5-70) Sec. 5-70. Virtual intensive outpatient program services. For dates of service on and after January 1, 2027, subject to any necessary federal approval, the medical assistance program shall provide coverage for virtual intensive outpatient program services when c…

(305 ILCS 5/5-8) (from Ch. 23, par. 5-8) Sec. 5-8. Practitioners. In supplying medical assistance, the Illinois Department may provide for the legally authorized services of (i) persons licensed under the Medical Practice Act of 1987, as amended, except as hereafter in this Secti…

(305 ILCS 5/5-9) (from Ch. 23, par. 5-9) Sec. 5-9. Choice of medical dispensers. Applicants and recipients shall be entitled to free choice of those qualified practitioners, hospitals, nursing homes, and other dispensers of medical services meeting the requirements and complying …

(305 ILCS 80/50) Sec. 50. Notice to public of available assistance. (a) The Department shall develop a brochure informing the public of the existence of funeral and burial assistance for the families of murdered children under this Act and make the brochure available on its websi…

(305 ILCS 60/50) Sec. 50. Effect on medical assistance program. (a) Nothing in this Act shall be construed so as to result in the elimination or reduction of any benefits or services covered under the medical assistance program under Article V of the Illinois Public Aid Code. (b)…

(305 ILCS 5/5A-1) (from Ch. 23, par. 5A-1) Sec. 5A-1. Definitions. As used in this Article, unless the context requires otherwise: "Fund" means the Hospital Provider Fund. "Hospital" means an institution, place, building, or agency located in this State that is subject to licensu…

(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 r…

(305 ILCS 5/5A-11) (from Ch. 23, par. 5A-11) Sec. 5A-11. Severability. If any clause, sentence, Section, exemption, provision, or part of this Article or the application thereof to any person or circumstance shall be adjudged to be unconstitutional or otherwise invalid, the remai…

(305 ILCS 5/5A-12.2) (This Section is scheduled to be repealed in accordance with 305 ILCS 5/5A-14) Sec. 5A-12.2. Hospital access payments on or after July 1, 2008. (a) To preserve and improve access to hospital services, for hospital services rendered on or after July 1, 2008, t…

(305 ILCS 5/5A-12.4) (This Section is scheduled to be repealed in accordance with 305 ILCS 5/5A-14) Sec. 5A-12.4. Hospital access improvement payments on or after June 10, 2012. (a) Hospital access improvement payments. To preserve and improve access to hospital services, for hos…

(305 ILCS 5/5A-12.5) Sec. 5A-12.5. Affordable Care Act adults; hospital access payments. (a) The Department shall, subject to federal approval, mirror the Medical Assistance hospital reimbursement methodology for Affordable Care Act adults who are enrolled under a fee-for-service…

(305 ILCS 5/5A-12.7) 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 subsec…

(305 ILCS 5/5A-12.8) 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, …

(305 ILCS 5/5A-13) 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 accorda…

(305 ILCS 5/5A-14) Sec. 5A-14. Repeal of assessments and disbursements. (a) (Blank). (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)…

(305 ILCS 5/5A-15) Sec. 5A-15. Protection of federal revenue. (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: (1) (i) if such finding is made before payments h…

(305 ILCS 5/5A-16) Sec. 5A-16. State fiscal year 2019 implementation protection. (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 paym…

(305 ILCS 5/5A-17) 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,…

(305 ILCS 5/5A-18) Sec. 5A-18. Advance payment reporting. Notwithstanding any provision of State law to the contrary, the Department of Healthcare and Family Services shall provide notice to the Director of the Governor's Office of Management and Budget, or the Director's designe…

(305 ILCS 5/5A-2) (from Ch. 23, par. 5A-2) 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 a…

(305 ILCS 5/5A-2.1) Sec. 5A-2.1. Continuation of Section 5A-2 of this Code; validation. (a) The General Assembly finds and declares that: (1) Public Act 101-650, which took effect on July 7, 2020, contained provisions that would have changed the repeal date for Section 5A-2 of th…

(305 ILCS 5/5A-3) (from Ch. 23, par. 5A-3) Sec. 5A-3. Exemptions. (a) (Blank). (b) A hospital provider that is a State agency, a State university, or a county with a population of 3,000,000 or more is exempt from the assessment imposed by Section 5A-2. (b-2) A hospital provider t…

(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 equal…

(305 ILCS 5/5A-5) (from Ch. 23, par. 5A-5) Sec. 5A-5. Notice; penalty; maintenance of records. (a) The Illinois Department shall send a notice of assessment to every hospital provider subject to assessment under this Article. The notice of assessment shall notify the hospital of …

(305 ILCS 5/5A-6) (from Ch. 23, par. 5A-6) Sec. 5A-6. Disposition of proceeds. The Illinois Department shall deposit all moneys received from hospital providers under this Article into the Hospital Provider Fund. Upon certification by the Illinois Department to the State Comptrol…

(305 ILCS 5/5A-7) (from Ch. 23, par. 5A-7) Sec. 5A-7. Administration; enforcement provisions. (a) The Illinois Department shall establish and maintain a listing of all hospital providers appearing in the licensing records of the Illinois Department of Public Health, which shall s…

(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 Med…

(305 ILCS 5/5A-9) (from Ch. 23, par. 5A-9) Sec. 5A-9. Emergency services audits. The Illinois Department may audit hospital claims for payment for emergency services provided to a recipient who does not require admission as an inpatient. The Illinois Department shall adopt rules …

(305 ILCS 5/5B-1) (from Ch. 23, par. 5B-1) Sec. 5B-1. Definitions. As used in this Article, unless the context requires otherwise: "Fund" means the Long-Term Care Provider Fund. "Long-term care facility" means (i) a nursing facility, whether public or private and whether organize…

(305 ILCS 5/5B-10) (from Ch. 23, par. 5B-10) Sec. 5B-10. Severability. If any clause, sentence, Section, exemption, provision, or part of this Article or the application thereof to any person or circumstance shall be adjudged to be unconstitutional or otherwise invalid, the remai…

(305 ILCS 5/5B-2) (from Ch. 23, par. 5B-2) Sec. 5B-2. Assessment; no local authorization to tax. (a) For the privilege of engaging in the occupation of long-term care provider, beginning July 1, 2011 through June 30, 2022, or upon federal approval by the Centers for Medicare and …

(305 ILCS 5/5B-3) (from Ch. 23, par. 5B-3) Sec. 5B-3. Exemptions. A long-term care provider which is a county with a population of more than 3 million that makes intergovernmental transfer payments as provided in Section 15-3 of this Code shall be exempt from the assessment impos…

(305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4) Sec. 5B-4. Payment of assessment; penalty. (a) The assessment imposed by Section 5B-2 shall be due and payable monthly, on the last State business day of the month for occupied bed days reported for the preceding third month prior to the…

(305 ILCS 5/5B-5) (from Ch. 23, par. 5B-5) Sec. 5B-5. Annual reporting; penalty; maintenance of records. (a) After December 31 of each year, and on or before March 31 of the succeeding year, every long-term care provider subject to assessment under this Article shall file a repor…