Provider Notice issued 06/08/2023

This is to inform you that the department has determined that your facility is subject to the inpatient and outpatient assessments imposed on Illinois hospital inpatient and outpatient services under the provisions of 305 ILCS 5/5-A and that the Department has posted the Assessment Adjustment Calculations to the Hospital Reimbursement Notifications Website under the Section Directed Payment and Passthrough Reports.

Your facility’s inpatient and outpatient assessment remittance notices for July 2023 through December 2023 of fiscal year 2024 per Public Act 101-0650, have been mailed via USPS Attn: Chief Financial Officer. Please make your mailroom aware of these important documents.

Also enclosed will be tax calculation worksheets detailing the bases for the inpatient and outpatient assessments. The remittance notice has the facility’s name and address, the tax identification number and personal identification number (PIN) assigned by the department, the total amount due, and the due date.

The required method of payment will be through ACH Direct Debit. If there have been any altered account information since the original ACH form was submitted to the Department in January 2023, please use the attached form to submit any changes and return to us via email to HFS.ProviderAssessmentUnit@illinois.gov. Additional copies of the ACH form can be found at hfs3848G.pdf (illinois.gov). With this direct debit method, your account will be debited on or about the 17th business day of each month.

In addition, each hospital is responsible for ensuring debit authorizations can be initiated from designated accounts in the appropriate dollar amount. The following is the company identification number to be given to your banking institution, if debit block filters are used on the hospital’s account. Please use the company identification number of 4550895818 with the ACH routing number of 091000019 for these transactions.

Fiscal Year 2024 Hospital Assessment (Fund 346) Due Dates