101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB3526

 

Introduced 2/14/2020, by Sen. Sara Feigenholtz

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.2  from Ch. 23, par. 5-5.2

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, in applying the regional wage adjuster component of the RUG-IV 48 reimbursement methodology, no adjuster shall be lower than 0.95. Effective immediately.


LRB101 17781 KTG 67209 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB3526LRB101 17781 KTG 67209 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 5-5.2 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.
14    (c) Notwithstanding any other provisions of this Code, the
15methodologies for reimbursement of nursing services as
16provided under this Article shall no longer be applicable for
17bills payable for nursing services rendered on or after a new
18reimbursement system based on the Resource Utilization Groups
19(RUGs) has been fully operationalized, which shall take effect
20for services provided on or after January 1, 2014.
21    (d) The new nursing services reimbursement methodology
22utilizing RUG-IV 48 grouper model, which shall be referred to
23as the RUGs reimbursement system, taking effect January 1,

 

 

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12014, shall be based on the following:
2        (1) The methodology shall be resident-driven,
3    facility-specific, and cost-based.
4        (2) Costs shall be annually rebased and case mix index
5    quarterly updated. The nursing services methodology will
6    be assigned to the Medicaid enrolled residents on record as
7    of 30 days prior to the beginning of the rate period in the
8    Department's Medicaid Management Information System (MMIS)
9    as present on the last day of the second quarter preceding
10    the rate period based upon the Assessment Reference Date of
11    the Minimum Data Set (MDS).
12        (3) Regional wage adjustors based on the Health Service
13    Areas (HSA) groupings and adjusters in effect on April 30,
14    2012 shall be included, except no adjuster shall be lower
15    than 0.95.
16        (4) Case mix index shall be assigned to each resident
17    class based on the Centers for Medicare and Medicaid
18    Services staff time measurement study in effect on July 1,
19    2013, utilizing an index maximization approach.
20        (5) The pool of funds available for distribution by
21    case mix and the base facility rate shall be determined
22    using the formula contained in subsection (d-1).
23    (d-1) Calculation of base year Statewide RUG-IV nursing
24base per diem rate.
25        (1) Base rate spending pool shall be:
26            (A) The base year resident days which are

 

 

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1        calculated by multiplying the number of Medicaid
2        residents in each nursing home as indicated in the MDS
3        data defined in paragraph (4) by 365.
4            (B) Each facility's nursing component per diem in
5        effect on July 1, 2012 shall be multiplied by
6        subsection (A).
7            (C) Thirteen million is added to the product of
8        subparagraph (A) and subparagraph (B) to adjust for the
9        exclusion of nursing homes defined in paragraph (5).
10        (2) For each nursing home with Medicaid residents as
11    indicated by the MDS data defined in paragraph (4),
12    weighted days adjusted for case mix and regional wage
13    adjustment shall be calculated. For each home this
14    calculation is the product of:
15            (A) Base year resident days as calculated in
16        subparagraph (A) of paragraph (1).
17            (B) The nursing home's regional wage adjustor
18        based on the Health Service Areas (HSA) groupings and
19        adjustors in effect on April 30, 2012.
20            (C) Facility weighted case mix which is the number
21        of Medicaid residents as indicated by the MDS data
22        defined in paragraph (4) multiplied by the associated
23        case weight for the RUG-IV 48 grouper model using
24        standard RUG-IV procedures for index maximization.
25            (D) The sum of the products calculated for each
26        nursing home in subparagraphs (A) through (C) above

 

 

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1        shall be the base year case mix, rate adjusted weighted
2        days.
3        (3) The Statewide RUG-IV nursing base per diem rate:
4            (A) on January 1, 2014 shall be the quotient of the
5        paragraph (1) divided by the sum calculated under
6        subparagraph (D) of paragraph (2); and
7            (B) on and after July 1, 2014, shall be the amount
8        calculated under subparagraph (A) of this paragraph
9        (3) plus $1.76.
10        (4) Minimum Data Set (MDS) comprehensive assessments
11    for Medicaid residents on the last day of the quarter used
12    to establish the base rate.
13        (5) Nursing facilities designated as of July 1, 2012 by
14    the Department as "Institutions for Mental Disease" shall
15    be excluded from all calculations under this subsection.
16    The data from these facilities shall not be used in the
17    computations described in paragraphs (1) through (4) above
18    to establish the base rate.
19    (e) Beginning July 1, 2014, the Department shall allocate
20funding in the amount up to $10,000,000 for per diem add-ons to
21the RUGS methodology for dates of service on and after July 1,
222014:
23        (1) $0.63 for each resident who scores in I4200
24    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
25        (2) $2.67 for each resident who scores either a "1" or
26    "2" in any items S1200A through S1200I and also scores in

 

 

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1    RUG groups PA1, PA2, BA1, or BA2.
2    (e-1) (Blank).
3    (e-2) For dates of services beginning January 1, 2014, the
4RUG-IV nursing component per diem for a nursing home shall be
5the product of the statewide RUG-IV nursing base per diem rate,
6the facility average case mix index, and the regional wage
7adjustor. Transition rates for services provided between
8January 1, 2014 and December 31, 2014 shall be as follows:
9        (1) The transition RUG-IV per diem nursing rate for
10    nursing homes whose rate calculated in this subsection
11    (e-2) is greater than the nursing component rate in effect
12    July 1, 2012 shall be paid the sum of:
13            (A) The nursing component rate in effect July 1,
14        2012; plus
15            (B) The difference of the RUG-IV nursing component
16        per diem calculated for the current quarter minus the
17        nursing component rate in effect July 1, 2012
18        multiplied by 0.88.
19        (2) The transition RUG-IV per diem nursing rate for
20    nursing homes whose rate calculated in this subsection
21    (e-2) is less than the nursing component rate in effect
22    July 1, 2012 shall be paid the sum of:
23            (A) The nursing component rate in effect July 1,
24        2012; plus
25            (B) The difference of the RUG-IV nursing component
26        per diem calculated for the current quarter minus the

 

 

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1        nursing component rate in effect July 1, 2012
2        multiplied by 0.13.
3    (f) Notwithstanding any other provision of this Code, on
4and after July 1, 2012, reimbursement rates associated with the
5nursing or support components of the current nursing facility
6rate methodology shall not increase beyond the level effective
7May 1, 2011 until a new reimbursement system based on the RUGs
8IV 48 grouper model has been fully operationalized.
9    (g) Notwithstanding any other provision of this Code, on
10and after July 1, 2012, for facilities not designated by the
11Department of Healthcare and Family Services as "Institutions
12for Mental Disease", rates effective May 1, 2011 shall be
13adjusted as follows:
14        (1) Individual nursing rates for residents classified
15    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
16    ending March 31, 2012 shall be reduced by 10%;
17        (2) Individual nursing rates for residents classified
18    in all other RUG IV groups shall be reduced by 1.0%;
19        (3) Facility rates for the capital and support
20    components shall be reduced by 1.7%.
21    (h) Notwithstanding any other provision of this Code, on
22and after July 1, 2012, nursing facilities designated by the
23Department of Healthcare and Family Services as "Institutions
24for Mental Disease" and "Institutions for Mental Disease" that
25are facilities licensed under the Specialized Mental Health
26Rehabilitation Act of 2013 shall have the nursing,

 

 

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1socio-developmental, capital, and support components of their
2reimbursement rate effective May 1, 2011 reduced in total by
32.7%.
4    (i) On and after July 1, 2014, the reimbursement rates for
5the support component of the nursing facility rate for
6facilities licensed under the Nursing Home Care Act as skilled
7or intermediate care facilities shall be the rate in effect on
8June 30, 2014 increased by 8.17%.
9    (j) Notwithstanding any other provision of law, subject to
10federal approval, effective July 1, 2019, sufficient funds
11shall be allocated for changes to rates for facilities licensed
12under the Nursing Home Care Act as skilled nursing facilities
13or intermediate care facilities for dates of services on and
14after July 1, 2019: (i) to establish a per diem add-on to the
15direct care per diem rate not to exceed $70,000,000 annually in
16the aggregate taking into account federal matching funds for
17the purpose of addressing the facility's unique staffing needs,
18adjusted quarterly and distributed by a weighted formula based
19on Medicaid bed days on the last day of the second quarter
20preceding the quarter for which the rate is being adjusted; and
21(ii) in an amount not to exceed $170,000,000 annually in the
22aggregate taking into account federal matching funds to permit
23the support component of the nursing facility rate to be
24updated as follows:
25        (1) 80%, or $136,000,000, of the funds shall be used to
26    update each facility's rate in effect on June 30, 2019

 

 

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1    using the most recent cost reports on file, which have had
2    a limited review conducted by the Department of Healthcare
3    and Family Services and will not hold up enacting the rate
4    increase, with the Department of Healthcare and Family
5    Services and taking into account subsection (i).
6        (2) After completing the calculation in paragraph (1),
7    any facility whose rate is less than the rate in effect on
8    June 30, 2019 shall have its rate restored to the rate in
9    effect on June 30, 2019 from the 20% of the funds set
10    aside.
11        (3) The remainder of the 20%, or $34,000,000, shall be
12    used to increase each facility's rate by an equal
13    percentage.
14    To implement item (i) in this subsection, facilities shall
15file quarterly reports documenting compliance with its
16annually approved staffing plan, which shall permit compliance
17with Section 3-202.05 of the Nursing Home Care Act. A facility
18that fails to meet the benchmarks and dates contained in the
19plan may have its add-on adjusted in the quarter following the
20quarterly review. Nothing in this Section shall limit the
21ability of the facility to appeal a ruling of non-compliance
22and a subsequent reduction to the add-on. Funds adjusted for
23noncompliance shall be maintained in the Long-Term Care
24Provider Fund and accounted for separately. At the end of each
25fiscal year, these funds shall be made available to facilities
26for special staffing projects.

 

 

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1    In order to provide for the expeditious and timely
2implementation of the provisions of Public Act 101-10 this
3amendatory Act of the 101st General Assembly, emergency rules
4to implement any provision of Public Act 101-10 this amendatory
5Act of the 101st General Assembly may be adopted in accordance
6with this subsection by the agency charged with administering
7that provision or initiative. The agency shall simultaneously
8file emergency rules and permanent rules to ensure that there
9is no interruption in administrative guidance. The 150-day
10limitation of the effective period of emergency rules does not
11apply to rules adopted under this subsection, and the effective
12period may continue through June 30, 2021. The 24-month
13limitation on the adoption of emergency rules does not apply to
14rules adopted under this subsection. The adoption of emergency
15rules authorized by this subsection is deemed to be necessary
16for the public interest, safety, and welfare.
17    (k) (j) During the first quarter of State Fiscal Year 2020,
18the Department of Healthcare of Family Services must convene a
19technical advisory group consisting of members of all trade
20associations representing Illinois skilled nursing providers
21to discuss changes necessary with federal implementation of
22Medicare's Patient-Driven Payment Model. Implementation of
23Medicare's Patient-Driven Payment Model shall, by September 1,
242020, end the collection of the MDS data that is necessary to
25maintain the current RUG-IV Medicaid payment methodology. The
26technical advisory group must consider a revised reimbursement

 

 

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1methodology that takes into account transparency,
2accountability, actual staffing as reported under the
3federally required Payroll Based Journal system, changes to the
4minimum wage, adequacy in coverage of the cost of care, and a
5quality component that rewards quality improvements.
6(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
7revised 9-18-19.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.