Sen. Don Harmon

Filed: 3/10/2017





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2    AMENDMENT NO. ______. Amend Senate Bill 1773 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.2 as follows:
6    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
7    Sec. 5-5.2. Payment.
8    (a) All nursing facilities that are grouped pursuant to
9Section 5-5.1 of this Act shall receive the same rate of
10payment for similar services.
11    (b) It shall be a matter of State policy that the Illinois
12Department shall utilize a uniform billing cycle throughout the
13State for the long-term care providers. The Department shall
14provide an update on the status of payments from both the
15General Revenue Fund and the Long-Term Care Provider Fund for
16expedited and non-expedited facilities by schedule. The



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1Department may provide the information monthly electronically,
2post it on the Department's website, or provide it upon request
3in compliance with this requirement.
4    (c) Notwithstanding any other provisions of this Code, the
5methodologies for reimbursement of nursing services as
6provided under this Article shall no longer be applicable for
7bills payable for nursing services rendered on or after a new
8reimbursement system based on the Resource Utilization Groups
9(RUGs) has been fully operationalized, which shall take effect
10for services provided on or after January 1, 2014.
11    (d) The new nursing services reimbursement methodology
12utilizing RUG-IV 48 grouper model, which shall be referred to
13as the RUGs reimbursement system, taking effect January 1,
142014, shall be based on the following:
15        (1) The methodology shall be resident-driven,
16    facility-specific, and cost-based.
17        (2) Costs shall be annually rebased and case mix index
18    quarterly updated. The nursing services methodology will
19    be assigned to the Medicaid enrolled residents on record as
20    of 30 days prior to the beginning of the rate period in the
21    Department's Medicaid Management Information System (MMIS)
22    as present on the last day of the second quarter preceding
23    the rate period based upon the Assessment Reference Date of
24    the Minimum Data Set (MDS).
25        (3) Regional wage adjustors based on the Health Service
26    Areas (HSA) groupings and adjusters in effect on April 30,



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1    2012 shall be included.
2        (4) Case mix index shall be assigned to each resident
3    class based on the Centers for Medicare and Medicaid
4    Services staff time measurement study in effect on July 1,
5    2013, utilizing an index maximization approach.
6        (5) The pool of funds available for distribution by
7    case mix and the base facility rate shall be determined
8    using the formula contained in subsection (d-1).
9    (d-1) Calculation of base year Statewide RUG-IV nursing
10base per diem rate.
11        (1) Base rate spending pool shall be:
12            (A) The base year resident days which are
13        calculated by multiplying the number of Medicaid
14        residents in each nursing home as indicated in the MDS
15        data defined in paragraph (4) by 365.
16            (B) Each facility's nursing component per diem in
17        effect on July 1, 2012 shall be multiplied by
18        subsection (A).
19            (C) Thirteen million is added to the product of
20        subparagraph (A) and subparagraph (B) to adjust for the
21        exclusion of nursing homes defined in paragraph (5).
22        (2) For each nursing home with Medicaid residents as
23    indicated by the MDS data defined in paragraph (4),
24    weighted days adjusted for case mix and regional wage
25    adjustment shall be calculated. For each home this
26    calculation is the product of:



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1            (A) Base year resident days as calculated in
2        subparagraph (A) of paragraph (1).
3            (B) The nursing home's regional wage adjustor
4        based on the Health Service Areas (HSA) groupings and
5        adjustors in effect on April 30, 2012.
6            (C) Facility weighted case mix which is the number
7        of Medicaid residents as indicated by the MDS data
8        defined in paragraph (4) multiplied by the associated
9        case weight for the RUG-IV 48 grouper model using
10        standard RUG-IV procedures for index maximization.
11            (D) The sum of the products calculated for each
12        nursing home in subparagraphs (A) through (C) above
13        shall be the base year case mix, rate adjusted weighted
14        days.
15        (3) The Statewide RUG-IV nursing base per diem rate:
16            (A) on January 1, 2014 shall be the quotient of the
17        paragraph (1) divided by the sum calculated under
18        subparagraph (D) of paragraph (2); and
19            (B) on and after July 1, 2014, shall be the amount
20        calculated under subparagraph (A) of this paragraph
21        (3) plus $1.76.
22        (4) Minimum Data Set (MDS) comprehensive assessments
23    for Medicaid residents on the last day of the quarter used
24    to establish the base rate.
25        (5) Nursing facilities designated as of July 1, 2012 by
26    the Department as "Institutions for Mental Disease" shall



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1    be excluded from all calculations under this subsection.
2    The data from these facilities shall not be used in the
3    computations described in paragraphs (1) through (4) above
4    to establish the base rate.
5    (e) Beginning July 1, 2014, the Department shall allocate
6funding in the amount up to $10,000,000 for per diem add-ons to
7the RUGS methodology for dates of service on and after July 1,
9        (1) $0.63 for each resident who scores in I4200
10    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
11        (2) $2.67 for each resident who scores either a "1" or
12    "2" in any items S1200A through S1200I and also scores in
13    RUG groups PA1, PA2, BA1, or BA2.
14    (e-1) (Blank).
15    (e-2) For dates of services beginning January 1, 2014, the
16RUG-IV nursing component per diem for a nursing home shall be
17the product of the statewide RUG-IV nursing base per diem rate,
18the facility average case mix index, and the regional wage
19adjustor. Transition rates for services provided between
20January 1, 2014 and December 31, 2014 shall be as follows:
21        (1) The transition RUG-IV per diem nursing rate for
22    nursing homes whose rate calculated in this subsection
23    (e-2) is greater than the nursing component rate in effect
24    July 1, 2012 shall be paid the sum of:
25            (A) The nursing component rate in effect July 1,
26        2012; plus



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1            (B) The difference of the RUG-IV nursing component
2        per diem calculated for the current quarter minus the
3        nursing component rate in effect July 1, 2012
4        multiplied by 0.88.
5        (2) The transition RUG-IV per diem nursing rate for
6    nursing homes whose rate calculated in this subsection
7    (e-2) is less than the nursing component rate in effect
8    July 1, 2012 shall be paid the sum of:
9            (A) The nursing component rate in effect July 1,
10        2012; plus
11            (B) The difference of the RUG-IV nursing component
12        per diem calculated for the current quarter minus the
13        nursing component rate in effect July 1, 2012
14        multiplied by 0.13.
15    (f) Notwithstanding any other provision of this Code, on
16and after July 1, 2012, reimbursement rates associated with the
17nursing or support components of the current nursing facility
18rate methodology shall not increase beyond the level effective
19May 1, 2011 until a new reimbursement system based on the RUGs
20IV 48 grouper model has been fully operationalized.
21    (g) Notwithstanding any other provision of this Code, on
22and after July 1, 2012, for facilities not designated by the
23Department of Healthcare and Family Services as "Institutions
24for Mental Disease", rates effective May 1, 2011 shall be
25adjusted as follows:
26        (1) Individual nursing rates for residents classified



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1    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
2    ending March 31, 2012 shall be reduced by 10%;
3        (2) Individual nursing rates for residents classified
4    in all other RUG IV groups shall be reduced by 1.0%;
5        (3) Facility rates for the capital and support
6    components shall be reduced by 1.7%.
7    (h) Notwithstanding any other provision of this Code, on
8and after July 1, 2012, nursing facilities designated by the
9Department of Healthcare and Family Services as "Institutions
10for Mental Disease" and "Institutions for Mental Disease" that
11are facilities licensed under the Specialized Mental Health
12Rehabilitation Act of 2013 shall have the nursing,
13socio-developmental, capital, and support components of their
14reimbursement rate effective May 1, 2011 reduced in total by
16    (i) On and after July 1, 2014, the reimbursement rates for
17the support component of the nursing facility rate for
18facilities licensed under the Nursing Home Care Act as skilled
19or intermediate care facilities shall be the rate in effect on
20June 30, 2014 increased by 8.17%.
21(Source: P.A. 98-104, Article 6, Section 6-240, eff. 7-22-13;
2298-104, Article 11, Section 11-35, eff. 7-22-13; 98-651, eff.
236-16-14; 98-727, eff. 7-16-14; 98-756, eff. 7-16-14; 99-78,
24eff. 7-20-15.)
25    Section 99. Effective date. This Act takes effect upon



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1becoming law.".