__________________________________________________________________________________________________________
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.
Your
facility’s inpatient and outpatient assessment remittance notices for July 2021
through December 2021 of fiscal year 2022 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.
Hospitals must remit the monthly assessments using the
Illinois State Treasurer’s E-Pay Program. In order to use this service, your
hospital will need an Internet connection, checking account information (bank
routing number and account number), from which the payment will be made, and
the hospital’s current remittance card. If your hospital is not familiar with
the Illinois
State Treasurer’s E-Pay Program, please contact
the Bureau of Hospital and Provider Services at (217) 524-7110 or via e-mail at
HFS.ProviderAssessmentUnit@illinois.gov.
In addition, each hospital is responsible for ensuring debit
authorizations can be initiated from designated accounts in the appropriate
dollar amount. The following are company identification numbers to be given to
your banking institution, if debit block filters are used on the hospital’s
account. Please use 1810599849 or 9810599849 for these transactions.
Following are instructions for remitting payment:
Link: https://epayHOSPITALASSESSMENTS.illinois.gov
Payment
Category: Hospital Assessment
Payment
Type: Hospital Assessments
Please enter
the following information to identify the payment:
Account Number: HFS ID # and PIN
JetPay Authorization Number: 8 digit code provided
by JetPay
Click: Search
Payment amount: Enter payment
amount in dollars and cents.
Click: Add Item and
Checkout
Enter Billing Contact Information
Click: Next Step: Add
Payment Method
Payment Method: eCheck
Enter payment information including bank
routing number and account number.
Click: Next Step: Review
Payment
Check Box: I agree to the
Payment Terms of Service.
Click: Make Payment
Thank you for your payment notification
screen may be e-mailed or printed.
If you have any questions concerning this information, please
do not hesitate to contact the Bureau of Rate Development and
Analysis by e-mail at HFS.ProviderAssessmentUnit@illinois.gov, or by telephone at 217-524-7110.![]()
Kathleen Staley,
Chief
Bureau of Rate
Development and Analysis
