97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB2290

 

Introduced 2/10/2011, by Sen. Toi W. Hutchinson

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.4  from Ch. 23, par. 5-5.4

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for facilities licensed by the Department of Public Health under the Nursing Home Care Act as Intermediate Care for the Developmentally Disabled facilities or Long Term Care for Under Age 22 facilities, the rates taking effect on July 1, 2011 shall include a 3% increase. Effective July 1, 2011.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB2290LRB097 09349 KTG 49484 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.4 as follows:
 
6    (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
7    Sec. 5-5.4. Standards of Payment - Department of Healthcare
8and Family Services. The Department of Healthcare and Family
9Services shall develop standards of payment of skilled nursing
10and intermediate care services in facilities providing such
11services under this Article which:
12    (1) Provide for the determination of a facility's payment
13for skilled nursing and intermediate care services on a
14prospective basis. The amount of the payment rate for all
15nursing facilities certified by the Department of Public Health
16under the MR/DD Community Care Act or the Nursing Home Care Act
17as Intermediate Care for the Developmentally Disabled
18facilities, Long Term Care for Under Age 22 facilities, Skilled
19Nursing facilities, or Intermediate Care facilities under the
20medical assistance program shall be prospectively established
21annually on the basis of historical, financial, and statistical
22data reflecting actual costs from prior years, which shall be
23applied to the current rate year and updated for inflation,

 

 

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1except that the capital cost element for newly constructed
2facilities shall be based upon projected budgets. The annually
3established payment rate shall take effect on July 1 in 1984
4and subsequent years. No rate increase and no update for
5inflation shall be provided on or after July 1, 1994 and before
6July 1, 2011, unless specifically provided for in this Section.
7The changes made by Public Act 93-841 extending the duration of
8the prohibition against a rate increase or update for inflation
9are effective retroactive to July 1, 2004. For facilities
10licensed by the Department of Public Health under the Nursing
11Home Care Act as Intermediate Care for the Developmentally
12Disabled facilities or Long Term Care for Under Age 22
13facilities, the rates taking effect on July 1, 2011 shall
14include a 3% increase.
15    For facilities licensed by the Department of Public Health
16under the Nursing Home Care Act as Intermediate Care for the
17Developmentally Disabled facilities or Long Term Care for Under
18Age 22 facilities, the rates taking effect on July 1, 1998
19shall include an increase of 3%. For facilities licensed by the
20Department of Public Health under the Nursing Home Care Act as
21Skilled Nursing facilities or Intermediate Care facilities,
22the rates taking effect on July 1, 1998 shall include an
23increase of 3% plus $1.10 per resident-day, as defined by the
24Department. For facilities licensed by the Department of Public
25Health under the Nursing Home Care Act as Intermediate Care
26Facilities for the Developmentally Disabled or Long Term Care

 

 

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1for Under Age 22 facilities, the rates taking effect on January
21, 2006 shall include an increase of 3%. For facilities
3licensed by the Department of Public Health under the Nursing
4Home Care Act as Intermediate Care Facilities for the
5Developmentally Disabled or Long Term Care for Under Age 22
6facilities, the rates taking effect on January 1, 2009 shall
7include an increase sufficient to provide a $0.50 per hour wage
8increase for non-executive staff.
9    For facilities licensed by the Department of Public Health
10under the Nursing Home Care Act as Intermediate Care for the
11Developmentally Disabled facilities or Long Term Care for Under
12Age 22 facilities, the rates taking effect on July 1, 1999
13shall include an increase of 1.6% plus $3.00 per resident-day,
14as defined by the Department. For facilities licensed by the
15Department of Public Health under the Nursing Home Care Act as
16Skilled Nursing facilities or Intermediate Care facilities,
17the rates taking effect on July 1, 1999 shall include an
18increase of 1.6% and, for services provided on or after October
191, 1999, shall be increased by $4.00 per resident-day, as
20defined by the Department.
21    For facilities licensed by the Department of Public Health
22under the Nursing Home Care Act as Intermediate Care for the
23Developmentally Disabled facilities or Long Term Care for Under
24Age 22 facilities, the rates taking effect on July 1, 2000
25shall include an increase of 2.5% per resident-day, as defined
26by the Department. For facilities licensed by the Department of

 

 

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1Public Health under the Nursing Home Care Act as Skilled
2Nursing facilities or Intermediate Care facilities, the rates
3taking effect on July 1, 2000 shall include an increase of 2.5%
4per resident-day, as defined by the Department.
5    For facilities licensed by the Department of Public Health
6under the Nursing Home Care Act as skilled nursing facilities
7or intermediate care facilities, a new payment methodology must
8be implemented for the nursing component of the rate effective
9July 1, 2003. The Department of Public Aid (now Healthcare and
10Family Services) shall develop the new payment methodology
11using the Minimum Data Set (MDS) as the instrument to collect
12information concerning nursing home resident condition
13necessary to compute the rate. The Department shall develop the
14new payment methodology to meet the unique needs of Illinois
15nursing home residents while remaining subject to the
16appropriations provided by the General Assembly. A transition
17period from the payment methodology in effect on June 30, 2003
18to the payment methodology in effect on July 1, 2003 shall be
19provided for a period not exceeding 3 years and 184 days after
20implementation of the new payment methodology as follows:
21        (A) For a facility that would receive a lower nursing
22    component rate per patient day under the new system than
23    the facility received effective on the date immediately
24    preceding the date that the Department implements the new
25    payment methodology, the nursing component rate per
26    patient day for the facility shall be held at the level in

 

 

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1    effect on the date immediately preceding the date that the
2    Department implements the new payment methodology until a
3    higher nursing component rate of reimbursement is achieved
4    by that facility.
5        (B) For a facility that would receive a higher nursing
6    component rate per patient day under the payment
7    methodology in effect on July 1, 2003 than the facility
8    received effective on the date immediately preceding the
9    date that the Department implements the new payment
10    methodology, the nursing component rate per patient day for
11    the facility shall be adjusted.
12        (C) Notwithstanding paragraphs (A) and (B), the
13    nursing component rate per patient day for the facility
14    shall be adjusted subject to appropriations provided by the
15    General Assembly.
16    For facilities licensed by the Department of Public Health
17under the Nursing Home Care Act as Intermediate Care for the
18Developmentally Disabled facilities or Long Term Care for Under
19Age 22 facilities, the rates taking effect on March 1, 2001
20shall include a statewide increase of 7.85%, as defined by the
21Department.
22    Notwithstanding any other provision of this Section, for
23facilities licensed by the Department of Public Health under
24the Nursing Home Care Act as skilled nursing facilities or
25intermediate care facilities, the numerator of the ratio used
26by the Department of Healthcare and Family Services to compute

 

 

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1the rate payable under this Section using the Minimum Data Set
2(MDS) methodology shall incorporate the following annual
3amounts as the additional funds appropriated to the Department
4specifically to pay for rates based on the MDS nursing
5component methodology in excess of the funding in effect on
6December 31, 2006:
7        (i) For rates taking effect January 1, 2007,
8    $60,000,000.
9        (ii) For rates taking effect January 1, 2008,
10    $110,000,000.
11        (iii) For rates taking effect January 1, 2009,
12    $194,000,000.
13    Notwithstanding any other provision of this Section, for
14facilities licensed by the Department of Public Health under
15the Nursing Home Care Act as skilled nursing facilities or
16intermediate care facilities, the support component of the
17rates taking effect on January 1, 2008 shall be computed using
18the most recent cost reports on file with the Department of
19Healthcare and Family Services no later than April 1, 2005,
20updated for inflation to January 1, 2006.
21    For facilities licensed by the Department of Public Health
22under the Nursing Home Care Act as Intermediate Care for the
23Developmentally Disabled facilities or Long Term Care for Under
24Age 22 facilities, the rates taking effect on April 1, 2002
25shall include a statewide increase of 2.0%, as defined by the
26Department. This increase terminates on July 1, 2002; beginning

 

 

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1July 1, 2002 these rates are reduced to the level of the rates
2in effect on March 31, 2002, as defined by the Department.
3    For facilities licensed by the Department of Public Health
4under the Nursing Home Care Act as skilled nursing facilities
5or intermediate care facilities, the rates taking effect on
6July 1, 2001 shall be computed using the most recent cost
7reports on file with the Department of Public Aid no later than
8April 1, 2000, updated for inflation to January 1, 2001. For
9rates effective July 1, 2001 only, rates shall be the greater
10of the rate computed for July 1, 2001 or the rate effective on
11June 30, 2001.
12    Notwithstanding any other provision of this Section, for
13facilities licensed by the Department of Public Health under
14the Nursing Home Care Act as skilled nursing facilities or
15intermediate care facilities, the Illinois Department shall
16determine by rule the rates taking effect on July 1, 2002,
17which shall be 5.9% less than the rates in effect on June 30,
182002.
19    Notwithstanding any other provision of this Section, for
20facilities licensed by the Department of Public Health under
21the Nursing Home Care Act as skilled nursing facilities or
22intermediate care facilities, if the payment methodologies
23required under Section 5A-12 and the waiver granted under 42
24CFR 433.68 are approved by the United States Centers for
25Medicare and Medicaid Services, the rates taking effect on July
261, 2004 shall be 3.0% greater than the rates in effect on June

 

 

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130, 2004. These rates shall take effect only upon approval and
2implementation of the payment methodologies required under
3Section 5A-12.
4    Notwithstanding any other provisions of this Section, for
5facilities licensed by the Department of Public Health under
6the Nursing Home Care Act as skilled nursing facilities or
7intermediate care facilities, the rates taking effect on
8January 1, 2005 shall be 3% more than the rates in effect on
9December 31, 2004.
10    Notwithstanding any other provision of this Section, for
11facilities licensed by the Department of Public Health under
12the Nursing Home Care Act as skilled nursing facilities or
13intermediate care facilities, effective January 1, 2009, the
14per diem support component of the rates effective on January 1,
152008, computed using the most recent cost reports on file with
16the Department of Healthcare and Family Services no later than
17April 1, 2005, updated for inflation to January 1, 2006, shall
18be increased to the amount that would have been derived using
19standard Department of Healthcare and Family Services methods,
20procedures, and inflators.
21    Notwithstanding any other provisions of this Section, for
22facilities licensed by the Department of Public Health under
23the Nursing Home Care Act as intermediate care facilities that
24are federally defined as Institutions for Mental Disease, a
25socio-development component rate equal to 6.6% of the
26facility's nursing component rate as of January 1, 2006 shall

 

 

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1be established and paid effective July 1, 2006. The
2socio-development component of the rate shall be increased by a
3factor of 2.53 on the first day of the month that begins at
4least 45 days after January 11, 2008 (the effective date of
5Public Act 95-707). As of August 1, 2008, the socio-development
6component rate shall be equal to 6.6% of the facility's nursing
7component rate as of January 1, 2006, multiplied by a factor of
83.53. The Illinois Department may by rule adjust these
9socio-development component rates, but in no case may such
10rates be diminished.
11    For facilities licensed by the Department of Public Health
12under the Nursing Home Care Act as Intermediate Care for the
13Developmentally Disabled facilities or as long-term care
14facilities for residents under 22 years of age, the rates
15taking effect on July 1, 2003 shall include a statewide
16increase of 4%, as defined by the Department.
17    For facilities licensed by the Department of Public Health
18under the Nursing Home Care Act as Intermediate Care for the
19Developmentally Disabled facilities or Long Term Care for Under
20Age 22 facilities, the rates taking effect on the first day of
21the month that begins at least 45 days after the effective date
22of this amendatory Act of the 95th General Assembly shall
23include a statewide increase of 2.5%, as defined by the
24Department.
25    Notwithstanding any other provision of this Section, for
26facilities licensed by the Department of Public Health under

 

 

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1the Nursing Home Care Act as skilled nursing facilities or
2intermediate care facilities, effective January 1, 2005,
3facility rates shall be increased by the difference between (i)
4a facility's per diem property, liability, and malpractice
5insurance costs as reported in the cost report filed with the
6Department of Public Aid and used to establish rates effective
7July 1, 2001 and (ii) those same costs as reported in the
8facility's 2002 cost report. These costs shall be passed
9through to the facility without caps or limitations, except for
10adjustments required under normal auditing procedures.
11    Rates established effective each July 1 shall govern
12payment for services rendered throughout that fiscal year,
13except that rates established on July 1, 1996 shall be
14increased by 6.8% for services provided on or after January 1,
151997. Such rates will be based upon the rates calculated for
16the year beginning July 1, 1990, and for subsequent years
17thereafter until June 30, 2001 shall be based on the facility
18cost reports for the facility fiscal year ending at any point
19in time during the previous calendar year, updated to the
20midpoint of the rate year. The cost report shall be on file
21with the Department no later than April 1 of the current rate
22year. Should the cost report not be on file by April 1, the
23Department shall base the rate on the latest cost report filed
24by each skilled care facility and intermediate care facility,
25updated to the midpoint of the current rate year. In
26determining rates for services rendered on and after July 1,

 

 

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11985, fixed time shall not be computed at less than zero. The
2Department shall not make any alterations of regulations which
3would reduce any component of the Medicaid rate to a level
4below what that component would have been utilizing in the rate
5effective on July 1, 1984.
6    (2) Shall take into account the actual costs incurred by
7facilities in providing services for recipients of skilled
8nursing and intermediate care services under the medical
9assistance program.
10    (3) Shall take into account the medical and psycho-social
11characteristics and needs of the patients.
12    (4) Shall take into account the actual costs incurred by
13facilities in meeting licensing and certification standards
14imposed and prescribed by the State of Illinois, any of its
15political subdivisions or municipalities and by the U.S.
16Department of Health and Human Services pursuant to Title XIX
17of the Social Security Act.
18    The Department of Healthcare and Family Services shall
19develop precise standards for payments to reimburse nursing
20facilities for any utilization of appropriate rehabilitative
21personnel for the provision of rehabilitative services which is
22authorized by federal regulations, including reimbursement for
23services provided by qualified therapists or qualified
24assistants, and which is in accordance with accepted
25professional practices. Reimbursement also may be made for
26utilization of other supportive personnel under appropriate

 

 

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1supervision.
2(Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707,
3eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09;
496-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff.
57-2-10.)
 
6    Section 99. Effective date. This Act takes effect July 1,
72011.