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Public Act 097-0010


 

Public Act 0010 97TH GENERAL ASSEMBLY

  
  
  

 


 
Public Act 097-0010
 
HB3207 EnrolledLRB097 10291 KTG 50497 b

    AN ACT concerning public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Public Aid Code is amended by
changing Sections 5-5.4, 5B-2, and 5B-4 as follows:
 
    (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
    Sec. 5-5.4. Standards of Payment - Department of Healthcare
and Family Services. The Department of Healthcare and Family
Services shall develop standards of payment of nursing facility
and ICF/DD services in facilities providing such services under
this Article which:
    (1) Provide for the determination of a facility's payment
for nursing facility or ICF/DD services on a prospective basis.
The amount of the payment rate for all nursing facilities
certified by the Department of Public Health under the MR/DD
Community Care Act or the Nursing Home Care Act as Intermediate
Care for the Developmentally Disabled facilities, Long Term
Care for Under Age 22 facilities, Skilled Nursing facilities,
or Intermediate Care facilities under the medical assistance
program shall be prospectively established annually on the
basis of historical, financial, and statistical data
reflecting actual costs from prior years, which shall be
applied to the current rate year and updated for inflation,
except that the capital cost element for newly constructed
facilities shall be based upon projected budgets. The annually
established payment rate shall take effect on July 1 in 1984
and subsequent years. No rate increase and no update for
inflation shall be provided on or after July 1, 1994 and before
July 1, 2012, unless specifically provided for in this Section.
The changes made by Public Act 93-841 extending the duration of
the prohibition against a rate increase or update for inflation
are effective retroactive to July 1, 2004.
    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, 1998
shall include an increase of 3%. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Skilled Nursing facilities or Intermediate Care facilities,
the rates taking effect on July 1, 1998 shall include an
increase of 3% plus $1.10 per resident-day, as defined by the
Department. For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
Facilities for the Developmentally Disabled or Long Term Care
for Under Age 22 facilities, the rates taking effect on January
1, 2006 shall include an increase of 3%. For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Intermediate Care Facilities for the
Developmentally Disabled or Long Term Care for Under Age 22
facilities, the rates taking effect on January 1, 2009 shall
include an increase sufficient to provide a $0.50 per hour wage
increase for non-executive staff.
    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, 1999
shall include an increase of 1.6% plus $3.00 per resident-day,
as defined by the Department. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Skilled Nursing facilities or Intermediate Care facilities,
the rates taking effect on July 1, 1999 shall include an
increase of 1.6% and, for services provided on or after October
1, 1999, shall be increased by $4.00 per resident-day, as
defined by the Department.
    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, 2000
shall include an increase of 2.5% per resident-day, as defined
by the Department. For facilities licensed by the Department of
Public Health under the Nursing Home Care Act as Skilled
Nursing facilities or Intermediate Care facilities, the rates
taking effect on July 1, 2000 shall include an increase of 2.5%
per resident-day, as defined by the Department.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities
or intermediate care facilities, a new payment methodology must
be implemented for the nursing component of the rate effective
July 1, 2003. The Department of Public Aid (now Healthcare and
Family Services) shall develop the new payment methodology
using the Minimum Data Set (MDS) as the instrument to collect
information concerning nursing home resident condition
necessary to compute the rate. The Department shall develop the
new payment methodology to meet the unique needs of Illinois
nursing home residents while remaining subject to the
appropriations provided by the General Assembly. A transition
period from the payment methodology in effect on June 30, 2003
to the payment methodology in effect on July 1, 2003 shall be
provided for a period not exceeding 3 years and 184 days after
implementation of the new payment methodology as follows:
        (A) For a facility that would receive a lower nursing
    component rate per patient day under the new system than
    the facility received effective on the date immediately
    preceding the date that the Department implements the new
    payment methodology, the nursing component rate per
    patient day for the facility shall be held at the level in
    effect on the date immediately preceding the date that the
    Department implements the new payment methodology until a
    higher nursing component rate of reimbursement is achieved
    by that facility.
        (B) For a facility that would receive a higher nursing
    component rate per patient day under the payment
    methodology in effect on July 1, 2003 than the facility
    received effective on the date immediately preceding the
    date that the Department implements the new payment
    methodology, the nursing component rate per patient day for
    the facility shall be adjusted.
        (C) Notwithstanding paragraphs (A) and (B), the
    nursing component rate per patient day for the facility
    shall be adjusted subject to appropriations provided by the
    General Assembly.
    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 March 1, 2001
shall include a statewide increase of 7.85%, as defined by the
Department.
    Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, except facilities participating
in the Department's demonstration program pursuant to the
provisions of Title 77, Part 300, Subpart T of the Illinois
Administrative Code, the numerator of the ratio used by the
Department of Healthcare and Family Services to compute the
rate payable under this Section using the Minimum Data Set
(MDS) methodology shall incorporate the following annual
amounts as the additional funds appropriated to the Department
specifically to pay for rates based on the MDS nursing
component methodology in excess of the funding in effect on
December 31, 2006:
        (i) For rates taking effect January 1, 2007,
    $60,000,000.
        (ii) For rates taking effect January 1, 2008,
    $110,000,000.
        (iii) For rates taking effect January 1, 2009,
    $194,000,000.
        (iv) For rates taking effect April 1, 2011, or the
    first day of the month that begins at least 45 days after
    the effective date of this amendatory Act of the 96th
    General Assembly, $416,500,000 or an amount as may be
    necessary to complete the transition to the MDS methodology
    for the nursing component of the rate. Increased payments
    under this item (iv) are not due and payable, however,
    until (i) the methodologies described in this paragraph are
    approved by the federal government in an appropriate State
    Plan amendment and (ii) the assessment imposed by Section
    5B-2 of this Code is determined to be a permissible tax
    under Title XIX of the Social Security Act.
    Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the support component of the
rates taking effect on January 1, 2008 shall be computed using
the most recent cost reports on file with the Department of
Healthcare and Family Services no later than April 1, 2005,
updated for inflation to January 1, 2006.
    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 April 1, 2002
shall include a statewide increase of 2.0%, as defined by the
Department. This increase terminates on July 1, 2002; beginning
July 1, 2002 these rates are reduced to the level of the rates
in effect on March 31, 2002, as defined by the Department.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities
or intermediate care facilities, the rates taking effect on
July 1, 2001 shall be computed using the most recent cost
reports on file with the Department of Public Aid no later than
April 1, 2000, updated for inflation to January 1, 2001. For
rates effective July 1, 2001 only, rates shall be the greater
of the rate computed for July 1, 2001 or the rate effective on
June 30, 2001.
    Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the Illinois Department shall
determine by rule the rates taking effect on July 1, 2002,
which shall be 5.9% less than the rates in effect on June 30,
2002.
    Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, if the payment methodologies
required under Section 5A-12 and the waiver granted under 42
CFR 433.68 are approved by the United States Centers for
Medicare and Medicaid Services, the rates taking effect on July
1, 2004 shall be 3.0% greater than the rates in effect on June
30, 2004. These rates shall take effect only upon approval and
implementation of the payment methodologies required under
Section 5A-12.
    Notwithstanding any other provisions of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the rates taking effect on
January 1, 2005 shall be 3% more than the rates in effect on
December 31, 2004.
    Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, effective January 1, 2009, the
per diem support component of the rates effective on January 1,
2008, computed using the most recent cost reports on file with
the Department of Healthcare and Family Services no later than
April 1, 2005, updated for inflation to January 1, 2006, shall
be increased to the amount that would have been derived using
standard Department of Healthcare and Family Services methods,
procedures, and inflators.
    Notwithstanding any other provisions of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as intermediate care facilities that
are federally defined as Institutions for Mental Disease, a
socio-development component rate equal to 6.6% of the
facility's nursing component rate as of January 1, 2006 shall
be established and paid effective July 1, 2006. The
socio-development component of the rate shall be increased by a
factor of 2.53 on the first day of the month that begins at
least 45 days after January 11, 2008 (the effective date of
Public Act 95-707). As of August 1, 2008, the socio-development
component rate shall be equal to 6.6% of the facility's nursing
component rate as of January 1, 2006, multiplied by a factor of
3.53. For services provided on or after April 1, 2011, or the
first day of the month that begins at least 45 days after the
effective date of this amendatory Act of the 96th General
Assembly, whichever is later, the Illinois Department may by
rule adjust these socio-development component rates, and may
use different adjustment methodologies for those facilities
participating, and those not participating, in the Illinois
Department's demonstration program pursuant to the provisions
of Title 77, Part 300, Subpart T of the Illinois Administrative
Code, but in no case may such rates be diminished below those
in effect on August 1, 2008.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or as long-term care
facilities for residents under 22 years of age, the rates
taking effect on July 1, 2003 shall include a statewide
increase of 4%, as defined by the Department.
    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 the first day of
the month that begins at least 45 days after the effective date
of this amendatory Act of the 95th General Assembly shall
include a statewide increase of 2.5%, as defined by the
Department.
    Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, effective January 1, 2005,
facility rates shall be increased by the difference between (i)
a facility's per diem property, liability, and malpractice
insurance costs as reported in the cost report filed with the
Department of Public Aid and used to establish rates effective
July 1, 2001 and (ii) those same costs as reported in the
facility's 2002 cost report. These costs shall be passed
through to the facility without caps or limitations, except for
adjustments required under normal auditing procedures.
    Rates established effective each July 1 shall govern
payment for services rendered throughout that fiscal year,
except that rates established on July 1, 1996 shall be
increased by 6.8% for services provided on or after January 1,
1997. Such rates will be based upon the rates calculated for
the year beginning July 1, 1990, and for subsequent years
thereafter until June 30, 2001 shall be based on the facility
cost reports for the facility fiscal year ending at any point
in time during the previous calendar year, updated to the
midpoint of the rate year. The cost report shall be on file
with the Department no later than April 1 of the current rate
year. Should the cost report not be on file by April 1, the
Department shall base the rate on the latest cost report filed
by each skilled care facility and intermediate care facility,
updated to the midpoint of the current rate year. In
determining rates for services rendered on and after July 1,
1985, fixed time shall not be computed at less than zero. The
Department shall not make any alterations of regulations which
would reduce any component of the Medicaid rate to a level
below what that component would have been utilizing in the rate
effective on July 1, 1984.
    (2) Shall take into account the actual costs incurred by
facilities in providing services for recipients of skilled
nursing and intermediate care services under the medical
assistance program.
    (3) Shall take into account the medical and psycho-social
characteristics and needs of the patients.
    (4) Shall take into account the actual costs incurred by
facilities in meeting licensing and certification standards
imposed and prescribed by the State of Illinois, any of its
political subdivisions or municipalities and by the U.S.
Department of Health and Human Services pursuant to Title XIX
of the Social Security Act.
    The Department of Healthcare and Family Services shall
develop precise standards for payments to reimburse nursing
facilities for any utilization of appropriate rehabilitative
personnel for the provision of rehabilitative services which is
authorized by federal regulations, including reimbursement for
services provided by qualified therapists or qualified
assistants, and which is in accordance with accepted
professional practices. Reimbursement also may be made for
utilization of other supportive personnel under appropriate
supervision.
    The Department shall develop enhanced payments to offset
the additional costs incurred by a facility serving exceptional
need residents and shall allocate at least $8,000,000 of the
funds collected from the assessment established by Section 5B-2
of this Code for such payments. For the purpose of this
Section, "exceptional needs" means, but need not be limited to,
ventilator care, tracheotomy care, bariatric care, complex
wound care, and traumatic brain injury care. The enhanced
payments for exceptional need residents under this paragraph
are not due and payable, however, until (i) the methodologies
described in this paragraph are approved by the federal
government in an appropriate State Plan amendment and (ii) the
assessment imposed by Section 5B-2 of this Code is determined
to be a permissible tax under Title XIX of the Social Security
Act.
    (5) Beginning July 1, 2012 the methodologies for
reimbursement of nursing facility services as provided under
this Section 5-5.4 shall no longer be applicable for bills
payable for State fiscal years 2012 and thereafter.
    (6) No payment increase under this Section for the MDS
methodology, exceptional care residents, or the
socio-development component rate established by Public Act
96-1530 of the 96th General Assembly and funded by the
assessment imposed under Section 5B-2 of this Code shall be due
and payable until after the Department notifies the long-term
care providers, in writing, that the payment methodologies to
long-term care providers required under this Section have been
approved by the Centers for Medicare and Medicaid Services of
the U.S. Department of Health and Human Services and the
waivers under 42 CFR 433.68 for the assessment imposed by this
Section, if necessary, have been granted by the Centers for
Medicare and Medicaid Services of the U.S. Department of Health
and Human Services. Upon notification to the Department of
approval of the payment methodologies required under this
Section and the waivers granted under 42 CFR 433.68, all
increased payments otherwise due under this Section prior to
the date of notification shall be due and payable within 90
days of the date federal approval is received.
(Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707,
eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09;
96-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10;
96-1530, eff. 2-16-11.)
 
    (305 ILCS 5/5B-2)  (from Ch. 23, par. 5B-2)
    Sec. 5B-2. Assessment; no local authorization to tax.
    (a) For the privilege of engaging in the occupation of
long-term care provider, beginning July 1, 2011 an assessment
is imposed upon each long-term care provider in an amount equal
to $6.07 times the number of occupied bed days due and payable
each month. Notwithstanding any provision of any other Act to
the contrary, this assessment shall be construed as a tax, but
may not be added to the charges of an individual's nursing home
care that is paid for in whole, or in part, by a federal,
State, or combined federal-state medical care program.
    (b) Nothing in this amendatory Act of 1992 shall be
construed to authorize any home rule unit or other unit of
local government to license for revenue or impose a tax or
assessment upon long-term care providers or the occupation of
long-term care provider, or a tax or assessment measured by the
income or earnings or occupied bed days of a long-term care
provider.
    (c) The assessment imposed by this Section shall not be due
and payable, however, until after the Department notifies the
long-term care providers, in writing, that the payment
methodologies to long-term care providers required under
Section 5-5.4 of this Code have been approved by the Centers
for Medicare and Medicaid Services of the U.S. Department of
Health and Human Services and the waivers under 42 CFR 433.68
for the assessment imposed by this Section, if necessary, have
been granted by the Centers for Medicare and Medicaid Services
of the U.S. Department of Health and Human Services.
(Source: P.A. 96-1530, eff. 2-16-11.)
 
    (305 ILCS 5/5B-4)  (from Ch. 23, par. 5B-4)
    Sec. 5B-4. Payment of assessment; penalty.
    (a) The assessment imposed by Section 5B-2 shall be due and
payable monthly, on the last State business day of the month
for occupied bed days reported for the preceding third month
prior to the month in which the tax is payable and due. A
facility that has delayed payment due to the State's failure to
reimburse for services rendered may request an extension on the
due date for payment pursuant to subsection (b) and shall pay
the assessment within 30 days of reimbursement by the
Department. The Illinois Department may provide that county
nursing homes directed and maintained pursuant to Section
5-1005 of the Counties Code may meet their assessment
obligation by certifying to the Illinois Department that county
expenditures have been obligated for the operation of the
county nursing home in an amount at least equal to the amount
of the assessment.
    (a-5) Each assessment payment shall be accompanied by an
assessment report to be completed by the long-term care
provider. A separate report shall be completed for each
long-term care facility in this State operated by a long-term
care provider. The report shall be in a form and manner
prescribed by the Illinois Department and shall at a minimum
provide for the reporting of the number of occupied bed days of
the long-term care facility for the reporting period and other
reasonable information the Illinois Department requires for
the administration of its responsibilities under this Code. To
the extent practicable, the Department shall coordinate the
assessment reporting requirements with other reporting
required of long-term care facilities.
    (b) The Illinois Department is authorized to establish
delayed payment schedules for long-term care providers that are
unable to make assessment payments when due under this Section
due to financial difficulties, as determined by the Illinois
Department. The Illinois Department may not deny a request for
delay of payment of the assessment imposed under this Article
if the long-term care provider has not been paid for services
provided during the month on which the assessment is levied.
    (c) If a long-term care provider fails to pay the full
amount of an assessment payment when due (including any
extensions granted under subsection (b)), there shall, unless
waived by the Illinois Department for reasonable cause, be
added to the assessment imposed by Section 5B-2 a penalty
assessment equal to the lesser of (i) 5% of the amount of the
assessment payment not paid on or before the due date plus 5%
of the portion thereof remaining unpaid on the last day of each
month thereafter or (ii) 100% of the assessment payment amount
not paid on or before the due date. For purposes of this
subsection, payments will be credited first to unpaid
assessment payment amounts (rather than to penalty or
interest), beginning with the most delinquent assessment
payments. Payment cycles of longer than 60 days shall be one
factor the Director takes into account in granting a waiver
under this Section.
    (c-5) If a long-term care provider fails to file its report
with payment, there shall, unless waived by the Illinois
Department for reasonable cause, be added to the assessment due
a penalty assessment equal to 25% of the assessment due.
    (d) Nothing in this amendatory Act of 1993 shall be
construed to prevent the Illinois Department from collecting
all amounts due under this Article pursuant to an assessment
imposed before the effective date of this amendatory Act of
1993.
    (e) Nothing in this amendatory Act of the 96th General
Assembly shall be construed to prevent the Illinois Department
from collecting all amounts due under this Code pursuant to an
assessment, tax, fee, or penalty imposed before the effective
date of this amendatory Act of the 96th General Assembly.
    (f) No installment of the assessment imposed by Section
5B-2 shall be due and payable until after the Department
notifies the long-term care providers, in writing, that the
payment methodologies to long-term care providers required
under Section 5-5.4 of this Code have been approved by the
Centers for Medicare and Medicaid Services of the U.S.
Department of Health and Human Services and the waivers under
42 CFR 433.68 for the assessment imposed by this Section, if
necessary, have been granted by the Centers for Medicare and
Medicaid Services of the U.S. Department of Health and Human
Services. Upon notification to the Department of approval of
the payment methodologies required under Section 5-5.4 of this
Code and the waivers granted under 42 CFR 433.68, all
installments otherwise due under Section 5B-4 prior to the date
of notification shall be due and payable to the Department upon
written direction from the Department within 90 days after
issuance by the Comptroller of the payments required under
Section 5-5.4 of this Code.
(Source: P.A. 96-444, eff. 8-14-09; 96-1530, eff. 2-16-11.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 6/14/2011