97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5046

 

Introduced 2/7/2012, by Rep. Roger L. Eddy - Michael W. Tryon - Chapin Rose

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Medical Assistance Article and the Long-Term Care Provider Funding Article of the Illinois Public Aid Code. Requires the revised methodology for reimbursement of nursing facility services to be based on the Resource Utilization Group methodology (RUGs) and to incorporate patient acuity, patient health outcomes, and measures of quality and quality improvement for the determination of payment. Removes language concerning rates that took effect April 1, 2011 and language concerning enhanced payments. Removes language concerning payment increases for the MDS methodology, exceptional care residents, or the socio-development established by Public Act 96-1530. Provides how licensed bed days shall be computed. Provides that beginning July 1, 2011 an assessment is imposed upon each long-term care provider in an amount equal to $2.04 (rather than $6.07) times the number of licensed (rather than occupied) bed days due and payable each month. Provides that assessments imposed on long-term care providers in excess of $1.50 per licensed bed day effective prior to July 1, 2011 shall not be due and payable until after the Department of Healthcare and Family Services notifies the long-term care providers, in writing, that the assessment is deemed permissible and certain waivers have been granted by the U.S. Department of Health and Human Services. Provides that the assessment shall not take effect or shall cease to be imposed, and any moneys remaining in the Long-Term Care Provider Fund shall be refunded to long-term care providers in proportion to the amounts paid by them, if certain conditions exist. Repeals the Nursing Home Licensing Fee Article of the Illinois Public Aid Code. Effective immediately.


LRB097 17708 KTG 62922 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB5046LRB097 17708 KTG 62922 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 Sections 5-5.2, 5-5.4, 5B-1, 5B-2, 5B-4, 5B-7, and
65B-8 as follows:
 
7    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
8    Sec. 5-5.2. Payment.
9    (a) All nursing facilities that are grouped pursuant to
10Section 5-5.1 of this Act shall receive the same rate of
11payment for similar services.
12    (b) It shall be a matter of State policy that the Illinois
13Department shall utilize a uniform billing cycle throughout the
14State for the long-term care providers.
15    (c) Notwithstanding any other provisions of this Code,
16beginning July 1, 2012 the methodologies for reimbursement of
17nursing facility services as provided under this Article shall
18no longer be applicable for bills payable for State fiscal
19years 2012 and thereafter. The Department of Healthcare and
20Family Services shall, effective July 1, 2012, implement an
21evidence-based payment methodology for the reimbursement of
22nursing facility services. The methodology shall continue to
23take into consideration the needs of individual residents, as

 

 

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1assessed and reported by the most current version of the
2nursing facility Resident Assessment Instrument, adopted and
3in use by the federal government. Additionally the revised
4methodology shall be based on the Resource Utilization Group
5methodology (RUGs) and must incorporate patient acuity,
6patient health outcomes, and measures of quality and quality
7improvement for the determination of payment.
8(Source: P.A. 96-1530, eff. 2-16-11.)
 
9    (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
10    Sec. 5-5.4. Standards of Payment - Department of Healthcare
11and Family Services. The Department of Healthcare and Family
12Services shall develop standards of payment of nursing facility
13and ICF/DD services in facilities providing such services under
14this Article which:
15    (1) Provide for the determination of a facility's payment
16for nursing facility or ICF/DD services on a prospective basis.
17The amount of the payment rate for all nursing facilities
18certified by the Department of Public Health under the ID/DD
19Community Care Act or the Nursing Home Care Act as Intermediate
20Care for the Developmentally Disabled facilities, Long Term
21Care for Under Age 22 facilities, Skilled Nursing facilities,
22or Intermediate Care facilities under the medical assistance
23program shall be prospectively established annually on the
24basis of historical, financial, and statistical data
25reflecting actual costs from prior years, which shall be

 

 

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1applied to the current rate year and updated for inflation,
2except that the capital cost element for newly constructed
3facilities shall be based upon projected budgets. The annually
4established payment rate shall take effect on July 1 in 1984
5and subsequent years. No rate increase and no update for
6inflation shall be provided on or after July 1, 1994 and before
7July 1, 2012, unless specifically provided for in this Section.
8The changes made by Public Act 93-841 extending the duration of
9the prohibition against a rate increase or update for inflation
10are effective retroactive to July 1, 2004.
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 Long Term Care for Under
14Age 22 facilities, the rates taking effect on July 1, 1998
15shall include an increase of 3%. For facilities licensed by the
16Department of Public Health under the Nursing Home Care Act as
17Skilled Nursing facilities or Intermediate Care facilities,
18the rates taking effect on July 1, 1998 shall include an
19increase of 3% plus $1.10 per resident-day, as defined by the
20Department. For facilities licensed by the Department of Public
21Health under the Nursing Home Care Act as Intermediate Care
22Facilities for the Developmentally Disabled or Long Term Care
23for Under Age 22 facilities, the rates taking effect on January
241, 2006 shall include an increase of 3%. For facilities
25licensed by the Department of Public Health under the Nursing
26Home Care Act as Intermediate Care Facilities for the

 

 

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1Developmentally Disabled or Long Term Care for Under Age 22
2facilities, the rates taking effect on January 1, 2009 shall
3include an increase sufficient to provide a $0.50 per hour wage
4increase for non-executive staff.
5    For facilities licensed by the Department of Public Health
6under the Nursing Home Care Act as Intermediate Care for the
7Developmentally Disabled facilities or Long Term Care for Under
8Age 22 facilities, the rates taking effect on July 1, 1999
9shall include an increase of 1.6% plus $3.00 per resident-day,
10as defined by the Department. For facilities licensed by the
11Department of Public Health under the Nursing Home Care Act as
12Skilled Nursing facilities or Intermediate Care facilities,
13the rates taking effect on July 1, 1999 shall include an
14increase of 1.6% and, for services provided on or after October
151, 1999, shall be increased by $4.00 per resident-day, as
16defined 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 July 1, 2000
21shall include an increase of 2.5% per resident-day, as defined
22by the Department. For facilities licensed by the Department of
23Public Health under the Nursing Home Care Act as Skilled
24Nursing facilities or Intermediate Care facilities, the rates
25taking effect on July 1, 2000 shall include an increase of 2.5%
26per resident-day, as defined by the Department.

 

 

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

 

 

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1        (B) For a facility that would receive a higher nursing
2    component rate per patient day under the payment
3    methodology in effect on July 1, 2003 than the facility
4    received effective on the date immediately preceding the
5    date that the Department implements the new payment
6    methodology, the nursing component rate per patient day for
7    the facility shall be adjusted.
8        (C) Notwithstanding paragraphs (A) and (B), the
9    nursing component rate per patient day for the facility
10    shall be adjusted subject to appropriations provided by the
11    General Assembly.
12    For facilities licensed by the Department of Public Health
13under the Nursing Home Care Act as Intermediate Care for the
14Developmentally Disabled facilities or Long Term Care for Under
15Age 22 facilities, the rates taking effect on March 1, 2001
16shall include a statewide increase of 7.85%, as defined by the
17Department.
18    Notwithstanding any other provision of this Section, for
19facilities licensed by the Department of Public Health under
20the Nursing Home Care Act as skilled nursing facilities or
21intermediate care facilities, except facilities participating
22in the Department's demonstration program pursuant to the
23provisions of Title 77, Part 300, Subpart T of the Illinois
24Administrative Code, the numerator of the ratio used by the
25Department of Healthcare and Family Services to compute the
26rate payable under this Section using the Minimum Data Set

 

 

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1(MDS) methodology shall incorporate the following annual
2amounts as the additional funds appropriated to the Department
3specifically to pay for rates based on the MDS nursing
4component methodology in excess of the funding in effect on
5December 31, 2006:
6        (i) For rates taking effect January 1, 2007,
7    $60,000,000.
8        (ii) For rates taking effect January 1, 2008,
9    $110,000,000.
10        (iii) For rates taking effect January 1, 2009,
11    $194,000,000.
12        (iv) (Blank). For rates taking effect April 1, 2011, or
13    the first day of the month that begins at least 45 days
14    after the effective date of this amendatory Act of the 96th
15    General Assembly, $416,500,000 or an amount as may be
16    necessary to complete the transition to the MDS methodology
17    for the nursing component of the rate. Increased payments
18    under this item (iv) are not due and payable, however,
19    until (i) the methodologies described in this paragraph are
20    approved by the federal government in an appropriate State
21    Plan amendment and (ii) the assessment imposed by Section
22    5B-2 of this Code is determined to be a permissible tax
23    under Title XIX of the Social Security Act.
24    Notwithstanding any other provision of this Section, for
25facilities licensed by the Department of Public Health under
26the Nursing Home Care Act as skilled nursing facilities or

 

 

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1intermediate care facilities, the support component of the
2rates taking effect on January 1, 2008 shall be computed using
3the most recent cost reports on file with the Department of
4Healthcare and Family Services no later than April 1, 2005,
5updated for inflation to January 1, 2006.
6    For facilities licensed by the Department of Public Health
7under the Nursing Home Care Act as Intermediate Care for the
8Developmentally Disabled facilities or Long Term Care for Under
9Age 22 facilities, the rates taking effect on April 1, 2002
10shall include a statewide increase of 2.0%, as defined by the
11Department. This increase terminates on July 1, 2002; beginning
12July 1, 2002 these rates are reduced to the level of the rates
13in effect on March 31, 2002, as defined by the Department.
14    For facilities licensed by the Department of Public Health
15under the Nursing Home Care Act as skilled nursing facilities
16or intermediate care facilities, the rates taking effect on
17July 1, 2001 shall be computed using the most recent cost
18reports on file with the Department of Public Aid no later than
19April 1, 2000, updated for inflation to January 1, 2001. For
20rates effective July 1, 2001 only, rates shall be the greater
21of the rate computed for July 1, 2001 or the rate effective on
22June 30, 2001.
23    Notwithstanding any other provision of this Section, for
24facilities licensed by the Department of Public Health under
25the Nursing Home Care Act as skilled nursing facilities or
26intermediate care facilities, the Illinois Department shall

 

 

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1determine by rule the rates taking effect on July 1, 2002,
2which shall be 5.9% less than the rates in effect on June 30,
32002.
4    Notwithstanding any other provision 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, if the payment methodologies
8required under Section 5A-12 and the waiver granted under 42
9CFR 433.68 are approved by the United States Centers for
10Medicare and Medicaid Services, the rates taking effect on July
111, 2004 shall be 3.0% greater than the rates in effect on June
1230, 2004. These rates shall take effect only upon approval and
13implementation of the payment methodologies required under
14Section 5A-12.
15    Notwithstanding any other provisions of this Section, for
16facilities licensed by the Department of Public Health under
17the Nursing Home Care Act as skilled nursing facilities or
18intermediate care facilities, the rates taking effect on
19January 1, 2005 shall be 3% more than the rates in effect on
20December 31, 2004.
21    Notwithstanding any other provision of this Section, for
22facilities licensed by the Department of Public Health under
23the Nursing Home Care Act as skilled nursing facilities or
24intermediate care facilities, effective January 1, 2009, the
25per diem support component of the rates effective on January 1,
262008, computed using the most recent cost reports on file with

 

 

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1the Department of Healthcare and Family Services no later than
2April 1, 2005, updated for inflation to January 1, 2006, shall
3be increased to the amount that would have been derived using
4standard Department of Healthcare and Family Services methods,
5procedures, and inflators.
6    Notwithstanding any other provisions of this Section, for
7facilities licensed by the Department of Public Health under
8the Nursing Home Care Act as intermediate care facilities that
9are federally defined as Institutions for Mental Disease, or
10facilities licensed by the Department of Public Health under
11the Specialized Mental Health Rehabilitation Facilities Act, a
12socio-development component rate equal to 6.6% of the
13facility's nursing component rate as of January 1, 2006 shall
14be established and paid effective July 1, 2006. The
15socio-development component of the rate shall be increased by a
16factor of 2.53 on the first day of the month that begins at
17least 45 days after January 11, 2008 (the effective date of
18Public Act 95-707). As of August 1, 2008, the socio-development
19component rate shall be equal to 6.6% of the facility's nursing
20component rate as of January 1, 2006, multiplied by a factor of
213.53. For services provided on or after July 1, 2012, April 1,
222011, or the first day of the month that begins at least 45
23days after the effective date of this amendatory Act of the
2496th General Assembly, whichever is later, the Illinois
25Department may by rule adjust these socio-development
26component rates, and may use different adjustment

 

 

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1methodologies for those facilities participating, and those
2not participating, in the Illinois Department's demonstration
3program pursuant to the provisions of Title 77, Part 300,
4Subpart T of the Illinois Administrative Code, but in no case
5may such rates be diminished below those in effect on August 1,
62008.
7    For facilities licensed by the Department of Public Health
8under the Nursing Home Care Act as Intermediate Care for the
9Developmentally Disabled facilities or as long-term care
10facilities for residents under 22 years of age, the rates
11taking effect on July 1, 2003 shall include a statewide
12increase of 4%, as defined by the Department.
13    For facilities licensed by the Department of Public Health
14under the Nursing Home Care Act as Intermediate Care for the
15Developmentally Disabled facilities or Long Term Care for Under
16Age 22 facilities, the rates taking effect on the first day of
17the month that begins at least 45 days after the effective date
18of this amendatory Act of the 95th General Assembly shall
19include a statewide increase of 2.5%, as defined by the
20Department.
21    Notwithstanding any other provision of this Section, for
22facilities licensed by the Department of Public Health under
23the Nursing Home Care Act as skilled nursing facilities or
24intermediate care facilities, effective January 1, 2005,
25facility rates shall be increased by the difference between (i)
26a facility's per diem property, liability, and malpractice

 

 

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1insurance costs as reported in the cost report filed with the
2Department of Public Aid and used to establish rates effective
3July 1, 2001 and (ii) those same costs as reported in the
4facility's 2002 cost report. These costs shall be passed
5through to the facility without caps or limitations, except for
6adjustments required under normal auditing procedures.
7    Rates established effective each July 1 shall govern
8payment for services rendered throughout that fiscal year,
9except that rates established on July 1, 1996 shall be
10increased by 6.8% for services provided on or after January 1,
111997. Such rates will be based upon the rates calculated for
12the year beginning July 1, 1990, and for subsequent years
13thereafter until June 30, 2001 shall be based on the facility
14cost reports for the facility fiscal year ending at any point
15in time during the previous calendar year, updated to the
16midpoint of the rate year. The cost report shall be on file
17with the Department no later than April 1 of the current rate
18year. Should the cost report not be on file by April 1, the
19Department shall base the rate on the latest cost report filed
20by each skilled care facility and intermediate care facility,
21updated to the midpoint of the current rate year. In
22determining rates for services rendered on and after July 1,
231985, fixed time shall not be computed at less than zero. The
24Department shall not make any alterations of regulations which
25would reduce any component of the Medicaid rate to a level
26below what that component would have been utilizing in the rate

 

 

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1effective on July 1, 1984.
2    (2) Shall take into account the actual costs incurred by
3facilities in providing services for recipients of skilled
4nursing and intermediate care services under the medical
5assistance program.
6    (3) Shall take into account the medical and psycho-social
7characteristics and needs of the patients.
8    (4) Shall take into account the actual costs incurred by
9facilities in meeting licensing and certification standards
10imposed and prescribed by the State of Illinois, any of its
11political subdivisions or municipalities and by the U.S.
12Department of Health and Human Services pursuant to Title XIX
13of the Social Security Act.
14    The Department of Healthcare and Family Services shall
15develop precise standards for payments to reimburse nursing
16facilities for any utilization of appropriate rehabilitative
17personnel for the provision of rehabilitative services which is
18authorized by federal regulations, including reimbursement for
19services provided by qualified therapists or qualified
20assistants, and which is in accordance with accepted
21professional practices. Reimbursement also may be made for
22utilization of other supportive personnel under appropriate
23supervision.
24    The Department shall develop enhanced payments to offset
25the additional costs incurred by a facility serving exceptional
26need residents and shall allocate at least $8,000,000 of the

 

 

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1funds collected from the assessment established by Section 5B-2
2of this Code for such payments. For the purpose of this
3Section, "exceptional needs" means, but need not be limited to,
4ventilator care, tracheotomy care, bariatric care, complex
5wound care, and traumatic brain injury care. The enhanced
6payments for exceptional need residents under this paragraph
7are not due and payable, however, until (i) the methodologies
8described in this paragraph are approved by the federal
9government in an appropriate State Plan amendment and (ii) the
10assessment imposed by Section 5B-2 of this Code is determined
11to be a permissible tax under Title XIX of the Social Security
12Act.
13    (5) Beginning July 1, 2012 the methodologies for
14reimbursement of nursing facility services as provided under
15this Section 5-5.4 shall no longer be applicable for bills
16payable for State fiscal years 2012 and thereafter.
17    (6) (Blank). No payment increase under this Section for the
18MDS methodology, exceptional care residents, or the
19socio-development component rate established by Public Act
2096-1530 of the 96th General Assembly and funded by the
21assessment imposed under Section 5B-2 of this Code shall be due
22and payable until after the Department notifies the long-term
23care providers, in writing, that the payment methodologies to
24long-term care providers required under this Section have been
25approved by the Centers for Medicare and Medicaid Services of
26the U.S. Department of Health and Human Services and the

 

 

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1waivers under 42 CFR 433.68 for the assessment imposed by this
2Section, if necessary, have been granted by the Centers for
3Medicare and Medicaid Services of the U.S. Department of Health
4and Human Services. Upon notification to the Department of
5approval of the payment methodologies required under this
6Section and the waivers granted under 42 CFR 433.68, all
7increased payments otherwise due under this Section prior to
8the date of notification shall be due and payable within 90
9days of the date federal approval is received.
10(Source: P.A. 96-45, eff. 7-15-09; 96-339, eff. 7-1-10; 96-959,
11eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1530, eff. 2-16-11;
1297-10, eff. 6-14-11; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12;
1397-584, eff. 8-26-11; revised 10-4-11.)
 
14    (305 ILCS 5/5B-1)  (from Ch. 23, par. 5B-1)
15    Sec. 5B-1. Definitions. As used in this Article, unless the
16context requires otherwise:
17    "Fund" means the Long-Term Care Provider Fund.
18    "Long-term care facility" means (i) a nursing facility,
19whether public or private and whether organized for profit or
20not-for-profit, that is subject to licensure by the Illinois
21Department of Public Health under the Nursing Home Care Act or
22the ID/DD Community Care Act, including a county nursing home
23directed and maintained under Section 5-1005 of the Counties
24Code, and (ii) a part of a hospital in which skilled or
25intermediate long-term care services within the meaning of

 

 

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1Title XVIII or XIX of the Social Security Act are provided;
2except that the term "long-term care facility" does not include
3a facility operated by a State agency or operated solely as an
4intermediate care facility for the mentally retarded within the
5meaning of Title XIX of the Social Security Act.
6    "Long-term care provider" means (i) a person licensed by
7the Department of Public Health to operate and maintain a
8skilled nursing or intermediate long-term care facility or (ii)
9a hospital provider that provides skilled or intermediate
10long-term care services within the meaning of Title XVIII or
11XIX of the Social Security Act. For purposes of this paragraph,
12"person" means any political subdivision of the State,
13municipal corporation, individual, firm, partnership,
14corporation, company, limited liability company, association,
15joint stock association, or trust, or a receiver, executor,
16trustee, guardian, or other representative appointed by order
17of any court. "Hospital provider" means a person licensed by
18the Department of Public Health to conduct, operate, or
19maintain a hospital.
20    "Occupied bed days" shall be computed separately for each
21long-term care facility operated or maintained by a long-term
22care provider, and means the sum for all beds of the number of
23days during the month on which each bed was occupied by a
24resident, other than a resident for whom Medicare Part A is the
25primary payer.
26    "Licensed bed days" shall be computed separately for each

 

 

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1nursing home operated or maintained by a nursing home provider
2and means, with respect to a nursing home provider, the sum for
3all nursing home beds of the number of days during a calendar
4quarter on which each bed is covered by a license issued to
5that provider under the Nursing Home Care Act or the Hospital
6Licensing Act.
7(Source: P.A. 96-339, eff. 7-1-10; 96-1530, eff. 2-16-11;
897-38, eff. 6-28-11; 97-227, eff. 1-1-12; revised 10-4-11.)
 
9    (305 ILCS 5/5B-2)  (from Ch. 23, par. 5B-2)
10    Sec. 5B-2. Assessment; no local authorization to tax.
11    (a) For the privilege of engaging in the occupation of
12long-term care provider, beginning July 1, 2011 an assessment
13is imposed upon each long-term care provider in an amount equal
14to $2.04 $6.07 times the number of licensed occupied bed days
15due and payable each month. Notwithstanding any provision of
16any other Act to the contrary, this assessment shall be
17construed as a tax, but shall not be billed or passed on to any
18resident of a nursing home operated by the nursing home
19provider.
20    (b) Nothing in this amendatory Act of 1992 shall be
21construed to authorize any home rule unit or other unit of
22local government to license for revenue or impose a tax or
23assessment upon long-term care providers or the occupation of
24long-term care provider, or a tax or assessment measured by the
25income or earnings or occupied bed days or licensed bed days of

 

 

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1a long-term care provider.
2    (c) The assessment imposed by this Section that is in
3excess of $1.50 per licensed bed day effective prior to July 1,
42011 shall not be due and payable, however, until after the
5Department notifies the long-term care providers, in writing,
6that the assessment is deemed permissible and the waivers under
742 CFR 433.68 for the assessment imposed by this Section, if
8necessary, have been granted by the Centers for Medicare and
9Medicaid Services of the U.S. Department of Health and Human
10Services shall not be due and payable, however, until after the
11Department notifies the long-term care providers, in writing,
12that the payment methodologies to long-term care providers
13required under Section 5-5.4 of this Code have been approved by
14the Centers for Medicare and Medicaid Services of the U.S.
15Department of Health and Human Services and the waivers under
1642 CFR 433.68 for the assessment imposed by this Section, if
17necessary, have been granted by the Centers for Medicare and
18Medicaid Services of the U.S. Department of Health and Human
19Services.
20    (d) The assessment imposed by this Section shall cease to
21be imposed if the assessment is determined to be an
22impermissible tax under Title XIX of the Social Security Act or
23a change in federal law no longer allows revenues from this
24assessment to be eligible for federal financial participation
25under Title XIX of the Social Security Act. Moneys in the
26Long-Term Care Provider Fund derived from assessments imposed

 

 

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1prior thereto shall be disbursed in accordance with Section
25B-8 to the extent federal financial participation is not
3reduced due to the impermissibility of the assessments, and any
4remaining moneys shall be refunded to long-term care providers
5in proportion to the amounts paid by them.
6    (e) The assessment imposed by this Section shall not take
7effect or shall cease to be imposed, and any moneys remaining
8in the Fund shall be refunded to long-term care providers in
9proportion to the amounts paid by them, if:
10        (1) the sum of General Revenue Fund resources for
11    payments to long-term care providers for the medical
12    assistance program are reduced below the amounts enacted
13    for the State fiscal year 2012; General Revenue Fund
14    resources for the purpose of this Section are defined as
15    any General Revenue appropriation specifically made for
16    long-term care providers or any payments made by other
17    State funds to long-term care providers and means the
18    amount originally enacted for State fiscal year 2012 and
19    may not be reduced for purposes of this Section by
20    allowable appropriation transfers or supplemental
21    appropriation legislation; or
22        (2) the Department of Healthcare and Family Services
23    adopts any administrative rule change to reduce payment
24    rates or alters any payment methodology that reduces any
25    payment rates made to operating long-term care providers
26    under the approved Title XIX or Title XXI State plan in

 

 

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1    effect April 1, 2011; or
2        (3) the new reimbursement methodology required by July
3    1, 2012 under Section 5-5.2 of this Code is funded less
4    than the aggregate amount required to fund the current rate
5    methodology in effect April 1, 2011 under the approved
6    Title XIX State plan. Amounts attributable to State plan
7    amendments that are pending, but not approved by April 1,
8    2011, are excluded for the purposes of this Section.
9(Source: P.A. 96-1530, eff. 2-16-11; 97-10, eff. 6-14-11;
1097-584, eff. 8-26-11.)
 
11    (305 ILCS 5/5B-4)  (from Ch. 23, par. 5B-4)
12    Sec. 5B-4. Payment of assessment; penalty.
13    (a) The assessment imposed by Section 5B-2 shall be due and
14payable monthly, on the last State business day of the month
15for licensed occupied bed days reported for the preceding third
16month prior to the month in which the tax is payable and due. A
17facility that has delayed payment due to the State's failure to
18reimburse for services rendered may request an extension on the
19due date for payment pursuant to subsection (b) and shall pay
20the assessment within 30 days of reimbursement by the
21Department. The Illinois Department may provide that county
22nursing homes directed and maintained pursuant to Section
235-1005 of the Counties Code may meet their assessment
24obligation by certifying to the Illinois Department that county
25expenditures have been obligated for the operation of the

 

 

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1county nursing home in an amount at least equal to the amount
2of the assessment.
3    (a-5) The Illinois Department shall provide for an
4electronic submission process for each long-term care facility
5to report at a minimum the number of occupied bed days of the
6long-term care facility for the reporting period and other
7reasonable information the Illinois Department requires for
8the administration of its responsibilities under this Code.
9Beginning July 1, 2013, a separate electronic submission shall
10be completed for each long-term care facility in this State
11operated by a long-term care provider. The Illinois Department
12shall prepare an assessment bill stating the amount due and
13payable each month and submit it to each long-term care
14facility via an electronic process. Each assessment payment
15shall be accompanied by a copy of the assessment bill sent to
16the long-term care facility by the Illinois Department. To the
17extent practicable, the Department shall coordinate the
18assessment reporting requirements with other reporting
19required of long-term care facilities.
20    (b) The Illinois Department is authorized to establish
21delayed payment schedules for long-term care providers that are
22unable to make assessment payments when due under this Section
23due to financial difficulties, as determined by the Illinois
24Department. The Illinois Department may not deny a request for
25delay of payment of the assessment imposed under this Article
26if the long-term care provider has not been paid for services

 

 

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1provided during the month on which the assessment is levied.
2    (c) If a long-term care provider fails to pay the full
3amount of an assessment payment when due (including any
4extensions granted under subsection (b)), there shall, unless
5waived by the Illinois Department for reasonable cause, be
6added to the assessment imposed by Section 5B-2 a penalty
7assessment equal to the lesser of (i) 5% of the amount of the
8assessment payment not paid on or before the due date plus 5%
9of the portion thereof remaining unpaid on the last day of each
10month thereafter or (ii) 100% of the assessment payment amount
11not paid on or before the due date. For purposes of this
12subsection, payments will be credited first to unpaid
13assessment payment amounts (rather than to penalty or
14interest), beginning with the most delinquent assessment
15payments. Payment cycles of longer than 60 days shall be one
16factor the Director takes into account in granting a waiver
17under this Section.
18    (c-5) If a long-term care facility fails to file its
19assessment bill with payment, there shall, unless waived by the
20Illinois Department for reasonable cause, be added to the
21assessment due a penalty assessment equal to 25% of the
22assessment due. After July 1, 2013, no penalty shall be
23assessed under this Section if the Illinois Department does not
24provide a process for the electronic submission of the
25information required by subsection (a-5).
26    (d) Nothing in this amendatory Act of 1993 shall be

 

 

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1construed to prevent the Illinois Department from collecting
2all amounts due under this Article pursuant to an assessment
3imposed before the effective date of this amendatory Act of
41993.
5    (e) Nothing in this amendatory Act of the 96th General
6Assembly shall be construed to prevent the Illinois Department
7from collecting all amounts due under this Code pursuant to an
8assessment, tax, fee, or penalty imposed before the effective
9date of this amendatory Act of the 96th General Assembly.
10    (f) No installment of the assessment imposed by Section
115B-2 shall be due and payable until after the Department
12notifies the long-term care providers, in writing, that the
13payment methodologies to long-term care providers required
14under Section 5-5.4 of this Code have been approved by the
15Centers for Medicare and Medicaid Services of the U.S.
16Department of Health and Human Services and the waivers under
1742 CFR 433.68 for the assessment imposed by this Section, if
18necessary, have been granted by the Centers for Medicare and
19Medicaid Services of the U.S. Department of Health and Human
20Services. Upon notification to the Department of approval of
21the payment methodologies required under Section 5-5.4 of this
22Code and the waivers granted under 42 CFR 433.68, all
23installments otherwise due under Section 5B-4 prior to the date
24of notification shall be due and payable to the Department upon
25written direction from the Department within 90 days after
26issuance by the Comptroller of the payments required under

 

 

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1Section 5-5.4 of this Code.
2(Source: P.A. 96-444, eff. 8-14-09; 96-1530, eff. 2-16-11;
397-10, eff. 6-14-11; 97-403, eff. 1-1-12; 97-584, eff. 8-26-11;
4revised 10-4-11.)
 
5    (305 ILCS 5/5B-7)  (from Ch. 23, par. 5B-7)
6    Sec. 5B-7. Administration; enforcement provisions.
7    (a) To the extent practicable, the Illinois Department
8shall administer and enforce this Article and collect the
9assessments, interest, and penalty assessments imposed under
10this Article, using procedures employed in its administration
11of this Code generally and, as it deems appropriate, in a
12manner similar to that in which the Department of Revenue
13administers and collects the retailers' occupation tax under
14the Retailers' Occupation Tax Act ("ROTA"). Instead of
15certificates of registration, the Illinois Department shall
16establish and maintain a listing of all long-term care
17providers appearing in the licensing records of the Department
18of Public Health, which shall show each provider's name,
19principal place of business, and the name and address of each
20long-term care facility operated or maintained by the provider
21in this State. In addition, the following provisions of the
22Retailers' Occupation Tax Act are incorporated by reference
23into this Section, except that the Illinois Department and its
24Director (rather than the Department of Revenue and its
25Director) and every long-term care provider subject to

 

 

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1assessment measured by licensed occupied bed days and to the
2return filing requirements of this Article (rather than persons
3subject to retailers' occupation tax measured by gross receipts
4from the sale of tangible personal property at retail and to
5the return filing requirements of ROTA) shall have the powers,
6duties, and rights specified in these ROTA provisions, as
7modified in this Section or by the Illinois Department in a
8manner consistent with this Article and except as manifestly
9inconsistent with the other provisions of this Article:
10        (1) ROTA, Section 4 (examination of return; notice of
11    correction; evidence; limitations; protest and hearing),
12    except that (i) the Illinois Department shall issue notices
13    of assessment liability (rather than notices of tax
14    liability as provided in ROTA, Section 4); (ii) in the case
15    of a fraudulent return or in the case of an extended period
16    agreed to by the Illinois Department and the long-term care
17    provider before the expiration of the limitation period, no
18    notice of assessment liability shall be issued more than 3
19    years after the later of the due date of the return
20    required by Section 5B-5 or the date the return (or an
21    amended return) was filed (rather within the period stated
22    in ROTA, Section 4); and (iii) the penalty provisions of
23    ROTA, Section 4 shall not apply.
24        (2) ROTA, Section 5 (failure to make return; failure to
25    pay assessment), except that the penalty and interest
26    provisions of ROTA, Section 5 shall not apply.

 

 

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1        (3) ROTA, Section 5a (lien; attachment; termination;
2    notice; protest; review; release of lien; status of lien).
3        (4) ROTA, Section 5b (State lien notices; State lien
4    index; duties of recorder and registrar of titles).
5        (5) ROTA, Section 5c (liens; certificate of release).
6        (6) ROTA, Section 5d (Department not required to
7    furnish bond; claim to property attached or levied upon).
8        (7) ROTA, Section 5e (foreclosure on liens;
9    enforcement).
10        (8) ROTA, Section 5f (demand for payment; levy and sale
11    of property; limitation).
12        (9) ROTA, Section 5g (sale of property; redemption).
13        (10) ROTA, Section 5j (sales on transfers outside usual
14    course of business; report; payment of assessment; rights
15    and duties of purchaser; penalty).
16        (11) ROTA, Section 6 (erroneous payments; credit or
17    refund), provided that (i) the Illinois Department may only
18    apply an amount otherwise subject to credit or refund to a
19    liability arising under this Article; (ii) except in the
20    case of an extended period agreed to by the Illinois
21    Department and the long term care provider prior to the
22    expiration of this limitation period, a claim for credit or
23    refund must be filed no more than 3 years after the due
24    date of the return required by Section 5B-5 (rather than
25    the time limitation stated in ROTA, Section 6); and (iii)
26    credits or refunds shall not bear interest.

 

 

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1        (12) ROTA, Section 6a (claims for credit or refund).
2        (13) ROTA, Section 6b (tentative determination of
3    claim; notice; hearing; review), provided that a long-term
4    care provider or its representative shall have 60 days
5    (rather than 20 days) within which to file a protest and
6    request for hearing in response to a tentative
7    determination of claim.
8        (14) ROTA, Section 6c (finality of tentative
9    determinations).
10        (15) ROTA, Section 8 (investigations and hearings).
11        (16) ROTA, Section 9 (witness; immunity).
12        (17) ROTA, Section 10 (issuance of subpoenas;
13    attendance of witnesses; production of books and records).
14        (18) ROTA, Section 11 (information confidential;
15    exceptions).
16        (19) ROTA, Section 12 (rules and regulations; hearing;
17    appeals), except that a long-term care provider shall not
18    be required to file a bond or be subject to a lien in lieu
19    thereof in order to seek court review under the
20    Administrative Review Law of a final assessment or revised
21    final assessment or the equivalent thereof issued by the
22    Illinois Department under this Article.
23    (b) In addition to any other remedy provided for and
24without sending a notice of assessment liability, the Illinois
25Department may collect an unpaid assessment by withholding, as
26payment of the assessment, reimbursements or other amounts

 

 

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1otherwise payable by the Illinois Department to the provider.
2(Source: P.A. 87-861.)
 
3    (305 ILCS 5/5B-8)  (from Ch. 23, par. 5B-8)
4    Sec. 5B-8. Long-Term Care Provider Fund.
5    (a) There is created in the State Treasury the Long-Term
6Care Provider Fund. Interest earned by the Fund shall be
7credited to the Fund. The Fund shall not be used to replace any
8moneys appropriated to the Medicaid program by the General
9Assembly.
10    (b) The Fund is created for the purpose of receiving and
11disbursing moneys in accordance with this Article.
12Disbursements from the Fund shall be made only as follows:
13        (1) For payments to nursing facilities, including
14    county nursing facilities but excluding State-operated
15    facilities, under Title XIX of the Social Security Act and
16    Article V of this Code.
17        (2) For the reimbursement of moneys collected by the
18    Illinois Department through error or mistake.
19        (3) For payment of administrative expenses incurred by
20    the Illinois Department or its agent in performing the
21    activities authorized by this Article.
22        (3.5) For reimbursement of expenses incurred by
23    long-term care facilities, and payment of administrative
24    expenses incurred by the Department of Public Health, in
25    relation to the conduct and analysis of background checks

 

 

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1    for identified offenders under the Nursing Home Care Act.
2        (4) For payments of any amounts that are reimbursable
3    to the federal government for payments from this Fund that
4    are required to be paid by State warrant.
5        (5) For making transfers to the General Obligation Bond
6    Retirement and Interest Fund, as those transfers are
7    authorized in the proceedings authorizing debt under the
8    Short Term Borrowing Act, but transfers made under this
9    paragraph (5) shall not exceed the principal amount of debt
10    issued in anticipation of the receipt by the State of
11    moneys to be deposited into the Fund.
12        (6) For making transfers, at the direction of the
13    Director of the Governor's Office of Management and Budget
14    during each fiscal year beginning on or after July 1, 2011,
15    to other State funds in an annual amount of $20,000,000 of
16    the tax collected pursuant to this Article for the purpose
17    of enforcement of nursing home standards, support of the
18    ombudsman program, and efforts to expand home and
19    community-based services. No transfer under this paragraph
20    shall occur until the assessment imposed by Section 5B-2 of
21    this Code is determined to be a permissible tax under Title
22    XIX of the Social Security Act. Additionally, no transfer
23    under this paragraph shall occur if any of the conditions
24    under subsection (d) of Section 5B-2 exist (i) the payment
25    methodologies created by Public Act 96-1530 under Section
26    5-5.4 of this Code have been approved by the Centers for

 

 

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1    Medicare and Medicaid Services of the U.S. Department of
2    Health and Human Services and (ii) the assessment imposed
3    by Section 5B-2 of this Code is determined to be a
4    permissible tax under Title XIX of the Social Security Act.
5    Disbursements from the Fund, other than transfers made
6pursuant to paragraphs (5) and (6) of this subsection, shall be
7by warrants drawn by the State Comptroller upon receipt of
8vouchers duly executed and certified by the Illinois
9Department.
10    (c) The Fund shall consist of the following:
11        (1) All moneys collected or received by the Illinois
12    Department from the long-term care provider assessment
13    imposed by this Article.
14        (2) All federal matching funds received by the Illinois
15    Department as a result of expenditures made by the Illinois
16    Department that are attributable to moneys deposited in the
17    Fund.
18        (3) Any interest or penalty levied in conjunction with
19    the administration of this Article.
20        (4) (Blank).
21        (5) All other monies received for the Fund from any
22    other source, including interest earned thereon.
23(Source: P.A. 96-1530, eff. 2-16-11; 97-584, eff. 8-26-11.)
 
24    (305 ILCS 5/Art. V-E rep.)
25    Section 10. The Illinois Public Aid Code is amended by

 

 

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1repealing Article V-E.
 
2    Section 99. Effective date. This Act takes effect upon
3becoming law.

 

 

HB5046- 32 -LRB097 17708 KTG 62922 b

1 INDEX
2 Statutes amended in order of appearance
3    305 ILCS 5/5-5.2from Ch. 23, par. 5-5.2
4    305 ILCS 5/5-5.4from Ch. 23, par. 5-5.4
5    305 ILCS 5/5B-1from Ch. 23, par. 5B-1
6    305 ILCS 5/5B-2from Ch. 23, par. 5B-2
7    305 ILCS 5/5B-4from Ch. 23, par. 5B-4
8    305 ILCS 5/5B-7from Ch. 23, par. 5B-7
9    305 ILCS 5/5B-8from Ch. 23, par. 5B-8
10    305 ILCS 5/Art. V-E rep.