Provider Notice issued 10/10/2023

Due to hospitals’ concerns regarding the State’s access to provider accounts to collect the monthly Hospital Provider Assessment payment, the Illinois Treasurer’s Office has set up a process by which facilities will initiate an electronic payment via ACH Credit or Wire Transfer through their own bank to pay the monthly Hospital Assessment fees.

Each hospital facility mandated to pay the Hospital Provider Assessment will be required to complete the attached ACH Vendor/Miscellaneous Payment Enrollment form (Standard Form 3881  and submit it to HFS.ProviderAssessmentUnit@Illinois.gov.  Once the Treasurer’s Office has completed their portion of the form, we will return it via email to the facility.  This should then be shared with the facility’s banking institution.  Included with the completed SF 3881 form, the Department will provide a list of informational fields which are required to be completed when submitting payment. Once HFS returns the completed SF 3881 form, the facility will be removed from the current collection process (if applicable).

ACH/Wire Transfers Form Completion Instructions

AGENCY INFORMATION

Federal Program Name:  Name of facility
Agency Identifier:            HFS
Agency Location Code:   478
ACH Format:                   CCD+ (ACH Credit)  OR  CTX (Wire Transfer)
Address:                         Facility address
Contact Person Name:    The person the IL Treasurer’s Office contacts to set up the ACH
Telephone Number:        Telephone number of Contact
Additional Information:   Email address of Contact

PAYEE/COMPANY INFORMATION

Name:                                          Illinois Healthcare and Family Services
SSN No or Taxpayer ID No:           371320188
Address:                                       201 South Grand Avenue East, Springfield, IL 62763
Contact Person Name:                  Donavon Patton
Telephone Number:                      217-785-9623

FINANCIAL INSTITUTION INFORMATION

This is completed by our Treasurer’s Office

Beginning with the December 2023 assessment, the Department will no longer sweep accounts; therefore, the above method must be in place before December 26, 2023, to pay the December assessment timely.  While in the past, the Department has accepted payment via check, statute does require that these assessment payments be submitted electronically. 

Questions regarding this notice may be directed to the Bureau of Rate Development and Analysis’ Provider Assessment Unit at 1-217-524-7110 or HFS.ProviderAssessmentUnit@illinois.gov.

Dan Jenkins, Deputy Administrator
Rates and Finance