REPORT OF THE
COMMITTEE ON HEALTH & HOSPITALS
The Honorable,
The Board of Commissioners of
ATTENDANCE
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Present: |
Chairman Butler, Vice Chairman Goslin, Commissioners
Claypool, Collins, Daley, Gorman, Maldonado, Moreno, Murphy, Peraica,
Quigley, Schneider, Silvestri, Sims, Steele and Suffredin (16) |
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Absent: |
Commissioner Beavers (1) |
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Also
Present: |
David Small, Chief Operating Officer – Bureau of Health
Services; Andrew Kane, Healthcare Consultant – Kane Consulting; Russell J. Pederson,
Senior Consultant - Sellers Feinberg |
Ladies and
Gentlemen:
Your Committee
on Health & Hospitals of the Board of Commissioners of Cook County met
pursuant to notice on
Your Committee
has considered the following items and upon adoption of this report, the
recommendations are as follows:
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291516 |
The following is a synopsis of the Proposed Ordinance: PROPOSED ORDINANCE BE IT ORDAINED, by the Cook County Board of
Commissioners that Chapter 38 Health and Human Services, Article IV, Sections
38-56 through 38-63 are hereby enacted as follows: Sec. 38-56. Definitions. Sec. 38-57. Assessment. Sec. 38-58. Exemptions. Sec. 38-59. Payment
of assessment; penalty. Sec. 38-60. Notice. Sec. 38-61. Disposition
of proceeds. Sec. 38-62. Applicability. Sec. 38-63. Hospital
access preservation payments. Effective Date: This Ordinance shall
become effective immediately upon passage. *Referred to the
Committee on Health & Hospitals on |
Chairman Butler asked Mr. David Small, Chief Operating
Officer, Bureau of Health Services to address the Commissioners.
Mr. Small gave the Commissioners a brief overview regarding
the State Fiscal Year 2008 Intergovernmental Transfer for Supplemental
Payments. Mr. Small provided the
Commissioners with a chart that speaks to how the Intergovernmental Transfer
for Supplemental Payments works. (See
attachment #1)
Further, Mr. Small stated that in terms of the existing Illinois
Plan it is due to Sunset, it will expire on
In conclusion Mr. Small stated it is incredibly critical
from a timing perspective that a plan be put forward, this is the only plan at
this point and time that is on the table that has stated benefits for
Commissioner Daley
moved approval of Communication No. 291516, seconded by Commissioner
Suffredin. Commissioner Peraica called
for a Roll Call, the vote of yeas and nays being as follows:
ROLL
CALL ON MOTION TO APPROVE
COMMUNICATION
NO. 291516
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Yeas: |
Chairman Butler, Vice Chairman Goslin, Commissioners
Claypool, Collins, Daley, Gorman, Maldonado, |
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Nay: |
Commissioner Peraica (1) |
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Present: |
None (0) |
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Absent: |
Commissioner Beavers (1) |
The motion to approve
CARRIED.
Chairman Butler asked the Secretary to the Board to call
upon the registered public speakers.
1) Sister
Shiela Lyne – President and Chief Executive Officer,
2) Ken
Robbins – President,
3) Kevin
Scanlan - President and CEO, Metropolitan Chicago Healthcare Council
4) Greg
Kelley – Secretary/Treasurer, SEIU Local 20
5) Dennis
Ryan – Vice President,
Chairman Butler requested that the additional documentation received
from public speakers and which was distributed to the Commissioners be made
part of the record. (Attachment #2)
Following is the
(Communication No.
291516), as approved:
PROPOSED ORDINANCE
BE IT ORDAINED, by the Cook County Board of
Commissioners that Chapter 38 Health and Human Services, Article IV, Sections
38-56 through 38-63 are hereby enacted as follows:
Sec. 38-56. Definitions.
The following words, terms and
phrases, when used in this division shall have the meanings ascribed to them in
this section, except where the context clearly indicates a different meaning:
Case Mix Index
means, for any given hospital, the quotient that is the result of dividing the
sum of DRG weights for all Medicaid admissions in State fiscal year 2005 by the
sum of Medicaid admissions in State fiscal year 2005. This calculation excludes
admissions for rehabilitation care, psychiatric care and transplants.
CMS means
the Centers for Medicare and Medicaid Services of the U.S. Department of Health
and Human Services.
DHFS means
the Illinois Department of Healthcare and Family Services.
DPH means
the Illinois Department of Public Health.
Fund means
the County Provider Trust Fund
Hospital means an institution, place, building,
or agency located in Cook County that is subject to licensure by the Illinois
Department of Public Health under the Hospital Licensing Act, whether public or
private and whether organized for profit or not-for-profit.
Hospital Provider means a person licensed by the Illinois Department of Public Health to
conduct, operate, or maintain a hospital, regardless of whether the person is a
Medicaid provider. For purposes of this
paragraph, “person” means any political subdivision of the State, municipal
corporation, individual, firm, partnership, corporation, company, limited
liability company, association, joint stock association, or trust, or receiver,
executor, trustee, guardian, or other representative appointed by order of the
court.
Medicaid Percentage means the State fiscal year 2005 Medicaid inpatient utilization rate.
Occupied Bed Days means the sum of the number of days that each bed was occupied by a
patient for all beds during calendar year 2005.
Occupied bed days shall be computed separately for each hospital
operated or maintained by a hospital provider.
The 2005 Annual Survey of Hospitals conducted by the Illinois Department
of Public Health will be the source data for Occupied bed days.
Revenue Department means the Cook County Department of Revenue.
Urban Area
means an area located within a metropolitan statistical area, as defined by the
U.S. Office of Management and Budget in OMB Bulletin 04-03, dated
Sec. 38-57. Assessment.
Subject to Sections 38-58
(Exemptions) and 38-62 (Applicability), Beginning July 1, 2008, an annual
assessment is imposed on each Hospital Provider in Cook County in an amount equal
to the Hospital’s occupied bed days multiplied by $184.72.
The Revenue Department shall use the
number of occupied bed days as reported by each hospital on the 2005 Annual
Survey of Hospitals conducted by the DPH to calculate the Hospital’s annual assessment. If there are data errors in the reported sum
of a hospital’s occupied bed days as determined by the Revenue Department, then
the County may obtain the sum of occupied 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
County or its duly authorized agents and employees.
Sec. 38-58. Exemptions.
(a)
A
Hospital Provider that is owned or operated by
the State or by an instrumentality of a unit of government within the State is
exempt from the assessment imposed by Section 38-57(Assessment).
(b)
A
Hospital Provider whose Hospital does not charge for its services is exempt
from the assessment imposed by Section 38-57 (Assessment).
Sec. 38-59. Payment of assessment; penalty
(a) Beginning
Upon notification of approval of the payment methodologies
listed under Section 38-63 (Hospital access preservation payments) and the
waiver under 42 CFR 433.68 for the assessment imposed by Section 38-57
(Assessment), if necessary, has been granted by the CMS; all monthly
installments otherwise due under Section 38-57 (Assessment) prior to the date
of notification shall be due and payable to the Revenue Department upon written
direction from the County and receipt of the payment methodologies listed under
Section 38-63 (Hospital access preservation payments).
(b) The Revenue 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 Revenue Department.
(c) If a Hospital Provider fails to pay the
full amount of an installment when due, there shall, unless waived by the
Revenue Department for reasonable cause, be added to the assessment imposed in
Section 38-57 (Assessment) a penalty equal to 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.
Section 38-60. Notice.
(a) The Revenue Department shall send an
annual notice of assessment to every Hospital Provider subject to assessment
under this Ordinance. The initial notice
of assessment shall notify the Hospital of its assessment and shall be sent
after receipt by the DHFS of notification from the CMS that the payment
methodologies listed under Section 38-63 (Hospital access preservation
payments) and, if necessary, the waiver granted under 42 CFR 433.68 have been
approved. The notice shall be on a form
prepared by the Revenue Department and shall state the following:
(1) The
name of the Hospital Provider.
(2) The
address of the Hospital Provider’s principal place of business from which the
provider engages in the occupation of hospital provider in this County, and the
name and address of each hospital operated, conducted, or maintained by the
provider in this County.
(3) The
occupied bed days, the annual amount of the assessment imposed under Section 38-57
(Assessment) and the amount of each monthly installment to be paid.
(4) Other
reasonable information as determined by the Revenue Department.
(b) If a Hospital Provider conducts, operates
or maintains more than one Hospital licensed by the DPH, the provider shall pay
the assessment for each Hospital separately.
(c) Notwithstanding any other provision in
this Ordinance, in the case of a person or entity that ceases to conduct,
operate, or maintain a hospital in respect of which the person is subject to
assessment under this Ordinance as a Hospital Provider, the assessment for the
year in which the cessation occurs shall be adjusted by multiplying the
assessment computed in under Section 38-57 (Assessment) by a fraction, the
numerator of which is the number of days in the year during which the provider
conducts, operates, or maintains the hospital and the denominator of which is
365. Immediately upon ceasing to
conduct, operate, or maintain a Hospital, the person or entity shall pay the
assessment for the year as so adjusted (to the extent not previously paid).
(d) Notwithstanding any other provision in
this Ordinance, a Hospital Provider who commences conducting, operating or
maintaining a Hospital, upon notice by the Revenue Department shall pay the
assessment computed under Section 38-57 (Assessment) and subsection (e) in
installments on the due dates occurring after the due dates of the initial
notice.
(e) Notwithstanding any other provision in
this Ordinance, in the case of a Hospital Provider that did not conduct,
operate, or maintain a Hospital throughout calendar year 2005, the assessment
for that Hospital Provider shall be computed on the basis of hypothetical
occupied bed days for the full calendar year as determined by the Revenue
Department.
(f) The Revenue Department shall provide a
Hospital Provider a reasonable opportunity to request a clarification or correction
of any clerical or computational errors contained in the calculation of its
assessment.
Section 38-61. Disposition
of proceeds.
On a monthly basis, the Revenue
Department shall deposit all monies received from Hospital Providers under this
Ordinance into the County Provider Trust Fund to be distributed to Hospitals,
including Hospitals that may be owned by the State or owned by an instrumentality of a unit of government within the State. Cook County through its Revenue and
Finance Department shall negotiate an administrative reimbursement fee with the
State to be paid to the County which shall be based on the administrative costs
to implement the Assessment in addition to the Hospital access preservation
payments.
Section 38-62. Applicability.
(a)
The
assessment imposed by Section 38-57 (Assessment) shall not take effect or shall
cease to be imposed if the DHFS makes changes in 89 Illinois Administrative
Code that reduce payments made to Hospital Providers following CMS approval of
these methodologies.
(b)
The
assessment imposed by Section 38-57 (Assessment) shall not take effect or shall
cease to be imposed if the assessment is determined to be an impermissible
assessment by the CMS.
Section 38-63. Hospital access preservation
payments.
The assessment imposed in Section
38-57 (Assessment) shall not be imposed until and unless the DHFS gains federal
approval and, subject to State appropriations, begins making payments for the
following rate methodologies which are in addition to payments made by DHFS
under existing reimbursement policies.
(a) To
preserve access to hospital services, the DHFS shall make payments to hospitals
as set forth in this Section, except for hospitals described in Section 38-58
for subsections (b) through (p). These
payments shall be made on a monthly basis beginning
(b) Obstetrical
care adjustment payments. The DHFS shall
pay each Cook County hospital that in State fiscal year 2005 had a Medicaid
inpatient utilization rate in excess of 35% and that in that same year provided
in excess of 3,750 Medicaid obstetrical days of care, an amount equal to $1,145
multiplied by each Medicaid obstetrical day of care provided by the hospital in
State fiscal year 2005.
(c) Medicaid
high volume adjustment payments. The
DHFS shall pay each general, acute care hospital with a case mix index greater than .5, and
that provided more Medicaid days of care in State fiscal year 2005 than in
State fiscal year 2003 and that in State fiscal year 2005 provided more than
12,000 Medicaid inpatient days of care and that is located in the county of
Cook or that in State fiscal year 2005 provided more than 28,000 Medicaid
inpatient days of care (including crossover days), an amount equal to $650
multiplied by each Medicaid day of care provided by the hospital in State
fiscal year 2005. Each hospital
qualifying for this payment will also be paid by the DHFS an additional amount
equal to $2,100 for each Medicaid inpatient day of care in excess of 27,000
days provided in State fiscal year 2005.
(d) Medicaid
services expansion payments. The DHFS
shall pay each Illinois general, acute care hospital with a case mix index
greater than .7 that also experienced at least a 20% increase in its Medicaid
inpatient utilization rate between State fiscal year 2005 and State fiscal year
2006 or each general, acute care hospital with a case mix index greater than
.65 that also experienced at least a 35% increase in its Medicaid inpatient utilization
rate between State fiscal year 2005 and State fiscal year 2006, an amount equal
to $1,650 multiplied by each Medicaid day of care provided by the hospital in
State fiscal year 2005. The DHFS will
also pay each general, acute care hospital with a case mix index greater than
.775 that also experienced at least a 25% increase in its Medicaid inpatient
utilization rate between State fiscal year 2004 and State fiscal year 2006 an
amount equal to $1,030 multiplied by each Medicaid day of care provided by the
hospital in State fiscal year 2005.
(e) High
Volume DSH payments. The DHFS shall pay
each hospital that in State fiscal year 2005 provided more than 30,000 Medicaid
inpatient days of care and that also had an MIUR in excess of 80%, an amount equal
to $360 multiplied by each Medicaid day of care provided by the hospital in
State fiscal year 2005.
(f) Psychiatric
services preservation payments.
(1) The DHFS shall pay each Illinois psychiatric
hospital that provided in excess of 4,000 Medicaid inpatient days in State
fiscal year 2005 and each general acute care hospital with a distinct part
psychiatric unit that provided over 4,000 Medicaid inpatient psychiatric days
in State fiscal year 2005 an amount equal to $235 multiplied by the number of
Medicaid inpatient psychiatric day of care provided in State fiscal year 2005.
(2) For each hospital qualifying under (e)
(1) that is paid a per diem rate for Medicaid inpatient psychiatric services
that, as of July 1, 2007, was less than $363.77 and that provided in excess of
16,000 Medicaid inpatient psychiatric days in State fiscal year 2005, the DHFS
will pay an amount equal to $480 multiplied by the number of Medicaid inpatient
psychiatric days of care provided in State fiscal year 2005.
(g) Trauma
center adjustment payments.
(1) The DHFS shall pay an additional payment
to each general acute care hospital that as of January 1, 2005, was designated
as a Level II trauma center and that had a case mix index in excess of
1.0. The payment shall equal $1,175
multiplied by the number of Medicaid inpatient days provided in State fiscal
year 2005.
(2) The DHFS shall pay an additional payment
to each children’s hospital that, as of
(h)
Acuity-based adjustment payments.
(1) The
DHFS shall pay each general acute care hospital having a case mix index in
excess of 1.0 and that provided in excess of 3,400 Medicaid inpatient days in
State fiscal year 2005, an amount equal to $525 multiplied by the number of
Illinois Medicaid inpatient days provided in State fiscal year 2005.
(2) The
DHFS shall pay each general acute care hospital having a case mix index in
excess of .8, that was deemed a disproportionate hospital by the DHFS in State
fiscal year 2005, and that provided in excess of 10,000 Medicaid inpatient days
in State fiscal year 2005, an amount equal to $820 multiplied by the number of
Illinois Medicaid inpatient days provided in State fiscal year 2005.
(3) The DHFS shall pay each general acute
care hospital having a case mix index in excess of .75 and that provided in
excess of 22,000 Medicaid inpatient days in State fiscal year 2005, an amount
equal to $175 multiplied by the number of Illinois Medicaid inpatient days
provided in State fiscal year 2005.
(i) Crossover
adjustment payments. The DHFS shall pay
each general, acute care hospital having a case mix index in excess of .725
and, for State fiscal year 2005, had a ratio of crossover days to total
Medicaid days in excess of 50%, an amount equal to $2,260 multiplied by the
number of Illinois Medicaid inpatient days provided in State fiscal year 2005.
(j) Rural
CHAP adjustment payments. The DHFS shall
pay each hospital that qualifies for Rural Critical Hospital Adjustment
Payments and that had a Medicaid obstetrical rate that was at least one-half
standard deviation above the mean Medicaid obstetrical rate during the CHAP
base period an amount equal to the annual Rural Critical Hospital Adjustment
Payment paid to these qualifying hospitals.
(k) Indigent
Care DSH payments. The DHFS shall pay
each qualifying hospital, reimbursement to defray costs associated with the
provision of care to the uninsured indigent.
(l) High
volume, high Medicaid outpatient payments.
The DHFS shall pay each hospital that provided in excess of 23,000
Medicaid ambulatory procedure listing services in State fiscal year 2005 that
also had a Medicaid percentage in excess of 50% or a general, acute care
disproportionate share hospital, an amount equal to $410 multiplied by the
number of Medicaid ambulatory procedure listing services provided in State
fiscal year 2005. Additionally, any
hospital eligible to receive these High volume, high Medicaid payments that
provided in excess of 45,000 Medicaid ambulatory procedure listing services in
State fiscal year 2005 will receive an add-on payment equal to $60 multiplied
by the number of Medicaid ambulatory procedure listing services provided in
State fiscal year 2005 in excess of 45,000.
(m) Emergency
care adjustment payments
(1) The DHFS shall pay each Illinois hospital
that provided in excess of 4,000 Medicaid Group 3 ambulatory procedure listing
services in State fiscal year 2005, had a Medicaid percentage in excess of 37%
and whose Medicaid Emergency level one ambulatory procedure listing services in
State fiscal year 2005 comprised more than 66.66% of its overall Medicaid Group
3 ambulatory procedure listing services in State fiscal year 2005, an amount
equal to $470 multiplied by the number of Medicaid Group 3 ambulatory procedure
listing services provided in State fiscal year 2005.
(2) The DHFS shall pay each Illinois hospital
that provided in excess of 7,700 Medicaid Group 3 ambulatory procedure listing
services in State fiscal year 2005, had a Medicaid percentage in excess of
24.5%, experienced Medicaid Group 3 ambulatory procedure listing services
growth in excess of 23% between State fiscal year 2003 and State fiscal year
2005 and whose Medicaid Emergency level one ambulatory procedure listing
services in State fiscal year 2005 comprised more than 33% of its overall
Medicaid Group 3 ambulatory procedure listing services in State fiscal year
2005, an amount equal to $375 multiplied by the number of Medicaid Group 3
ambulatory procedure listing services provided in State fiscal year 2005.
(n) Complexity
of care outpatient adjustment payments.
The DHFS shall pay each Illinois hospital located in an urban area that
provided in excess of 2,500 Medicaid Group 2 ambulatory procedure listing
services in State fiscal year 2005, experienced Medicaid Group 2 ambulatory
procedure listing services growth in excess of 33% between State fiscal year
2003 and State fiscal year 2005 and whose Medicaid group 2(a) ambulatory
procedure listing services in State fiscal year 2005 comprised more than 35% of
its overall Medicaid Group 2 ambulatory procedure listing services in State
fiscal year 2005, an amount equal to $660 multiplied by the number of Medicaid
Group 2 ambulatory procedure listing services provided in State fiscal year
2005.
(o) Outpatient
access preservation payments. The DHFS shall pay each Cook County hospital that
experienced Medicaid ambulatory procedure listing services growth in excess of
15% between State fiscal year 2003 and State fiscal year 2005, an amount equal
to $1,975 multiplied by the percentage growth in Medicaid ambulatory procedure
listing services provided between State fiscal year 2003 and State fiscal year
2005 multiplied by the number of Medicaid ambulatory procedure listing services
provided in State fiscal year 2005.
(p) Rehabilitation
outpatient adjustment payments. The DHFS
shall pay each hospital that provided more than 5,000 Medicaid Group 6(a)
ambulatory procedure listing services in State fiscal year 2005, an amount
equal to $990 multiplied by the number of Medicaid Group 6(a) ambulatory
procedure listing services provided in State fiscal year 2005.
(q)
Comprehensive outpatient base adjustment payments. Beginning with dates of service on or after
(r) The
DHFS shall pay John H. Stroger Jr. Hospital of Cook County an amount equal to
$1,333 multiplied by each Medicaid day of care provided by the hospital in
State fiscal year 2005.
(s) For
purposes of this Section, the terms “Medicaid days”, “ambulatory procedure
listing services”, and “ambulatory procedure listing payments” do not include
any days, charges, or services for which Medicare was liable for payment,
except where explicitly stated otherwise in this Section.
Effective Date: This Ordinance shall
become effective immediately upon passage.
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291523 |
RESOLUTION REQUIRING THE COOK COUNTY BUREAU OF HEALTH
SERVICES AND ITS AFFILIATES CONTINUE TO INCLUDE ACCOUNT, GRADE, STEP, BUDGET
AND POSITION IDENTIFICATION INFORMATION AS WELL AS ADD SALARY INFORMATION ON
ALL REQUESTS TO APPROVE MEDICAL STAFF APPOINTMENTS, REAPPOINTMENTS, MEDICAL
STATUS CHANGES AND MID-LEVEL PRACTITIONER APPOINTMENTS AND REAPPOINTMENTS FOR
APPOINTEES WHO ARE ALSO EMPLOYEES OF THE COUNTY (PROPOSED RESOLUTION). Submitting a Proposed Resolution sponsored
by Robert B. Steele, County Commissioner. PROPOSED RESOLUTION WHEREAS, the Cook County Board of Commissioners approves medical
staff appointments, reappointments, medical staff status changes and
mid-level practitioner appointments and reappointments for the hospitals in
the Cook County Bureau of Health Services; and WHEREAS, for informational purposes the Cook County Board of
Commissioners receives account, grade, step, budget and position
identification information when approving medical staff appointments,
reappointments, medical staff status changes and mid-level practitioner
appointments and reappointments for appointees who are also employees of the
County; and WHEREAS, in addition to receiving account, grade, step, budget
and position identification information on requests to approve medical staff
appointments, reappointments, medical staff status changes and mid-level
practitioner appointments and reappointments for appointees who are also
employees of the County, specific salary information shall also be included
for informational purposes only. NOW, THEREFORE, BE IT RESOLVED, that the hospitals in the Cook
County Bureau of Health Services continue to include account, grade, step,
budget and position identification information as well as add salary
information on all requests to approve medical staff appointments,
reappointments, medical status changes and mid-level practitioner
appointments and reappointments for appointees who are also employees of the
County. *Referred to the
Committee on Health & Hospitals on |
Commissioner Steele,
seconded by Commissioner Silvestri, moved the approval of Communication No.
291523. The motion carried.
Commissioner Silvestri
moved to adjourn the meeting, seconded by Commissioner Daley. The motion carried and the meeting was
adjourned.
YOUR COMMITTEE
RECOMMENDS THE FOLLOWING ACTION
WITH REGARD TO THE
MATTER NAMED HEREIN:
Communication Number
291516 Approved
Communication Number
291523 Approved
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Respectfully
submitted, Committee
on Health & Hospitals xxxxxxxxxxxxxxxxxxxxxxxxxxxx Jerry
Butler, Chairman |
Attest:
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Matthew B. DeLeon, Secretary
** The audio recording for this meeting is available from
the Office of the Secretary to the Board,