97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB5561

 

Introduced 2/15/2012, by Rep. Greg Harris

 

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

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning standards of payment of skilled nursing and intermediate care services.


LRB097 14500 KTG 59355 b

 

 

A BILL FOR

 

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

 

 

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1except that the capital cost element for newly constructed
2facilities shall be based upon projected budgets. The annually
3established payment rate shall take effect on July 1 in 1984
4and subsequent years. No rate increase and no update for
5inflation shall be provided on or after July 1, 1994 and before
6July 1, 2012, unless specifically provided for in this Section.
7The changes made by Public Act 93-841 extending the duration of
8the prohibition against a rate increase or update for inflation
9are effective retroactive to July 1, 2004.
10    For facilities licensed by the Department of Public Health
11under the Nursing Home Care Act as Intermediate Care for the
12Developmentally Disabled facilities or Long Term Care for Under
13Age 22 facilities, the rates taking effect on July 1, 1998
14shall include an increase of 3%. For facilities licensed by the
15Department of Public Health under the Nursing Home Care Act as
16Skilled Nursing facilities or Intermediate Care facilities,
17the rates taking effect on July 1, 1998 shall include an
18increase of 3% plus $1.10 per resident-day, as defined by the
19Department. For facilities licensed by the Department of Public
20Health under the Nursing Home Care Act as Intermediate Care
21Facilities for the Developmentally Disabled or Long Term Care
22for Under Age 22 facilities, the rates taking effect on January
231, 2006 shall include an increase of 3%. For facilities
24licensed by the Department of Public Health under the Nursing
25Home Care Act as Intermediate Care Facilities for the
26Developmentally Disabled or Long Term Care for Under Age 22

 

 

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1facilities, the rates taking effect on January 1, 2009 shall
2include an increase sufficient to provide a $0.50 per hour wage
3increase for non-executive staff.
4    For facilities licensed by the Department of Public Health
5under the Nursing Home Care Act as Intermediate Care for the
6Developmentally Disabled facilities or Long Term Care for Under
7Age 22 facilities, the rates taking effect on July 1, 1999
8shall include an increase of 1.6% plus $3.00 per resident-day,
9as defined by the Department. For facilities licensed by the
10Department of Public Health under the Nursing Home Care Act as
11Skilled Nursing facilities or Intermediate Care facilities,
12the rates taking effect on July 1, 1999 shall include an
13increase of 1.6% and, for services provided on or after October
141, 1999, shall be increased by $4.00 per resident-day, as
15defined by the Department.
16    For facilities licensed by the Department of Public Health
17under the Nursing Home Care Act as Intermediate Care for the
18Developmentally Disabled facilities or Long Term Care for Under
19Age 22 facilities, the rates taking effect on July 1, 2000
20shall include an increase of 2.5% per resident-day, as defined
21by the Department. For facilities licensed by the Department of
22Public Health under the Nursing Home Care Act as Skilled
23Nursing facilities or Intermediate Care facilities, the rates
24taking effect on July 1, 2000 shall include an increase of 2.5%
25per resident-day, as defined by the Department.
26    For facilities licensed by the Department of Public Health

 

 

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

 

 

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

 

 

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

 

 

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

 

 

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1which shall be 5.9% less than the rates in effect on June 30,
22002.
3    Notwithstanding any other provision of this Section, for
4facilities licensed by the Department of Public Health under
5the Nursing Home Care Act as skilled nursing facilities or
6intermediate care facilities, if the payment methodologies
7required under Section 5A-12 and the waiver granted under 42
8CFR 433.68 are approved by the United States Centers for
9Medicare and Medicaid Services, the rates taking effect on July
101, 2004 shall be 3.0% greater than the rates in effect on June
1130, 2004. These rates shall take effect only upon approval and
12implementation of the payment methodologies required under
13Section 5A-12.
14    Notwithstanding any other provisions of this Section, for
15facilities licensed by the Department of Public Health under
16the Nursing Home Care Act as skilled nursing facilities or
17intermediate care facilities, the rates taking effect on
18January 1, 2005 shall be 3% more than the rates in effect on
19December 31, 2004.
20    Notwithstanding any other provision of this Section, for
21facilities licensed by the Department of Public Health under
22the Nursing Home Care Act as skilled nursing facilities or
23intermediate care facilities, effective January 1, 2009, the
24per diem support component of the rates effective on January 1,
252008, computed using the most recent cost reports on file with
26the Department of Healthcare and Family Services no later than

 

 

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1April 1, 2005, updated for inflation to January 1, 2006, shall
2be increased to the amount that would have been derived using
3standard Department of Healthcare and Family Services methods,
4procedures, and inflators.
5    Notwithstanding any other provisions of this Section, for
6facilities licensed by the Department of Public Health under
7the Nursing Home Care Act as intermediate care facilities that
8are federally defined as Institutions for Mental Disease, or
9facilities licensed by the Department of Public Health under
10the Specialized Mental Health Rehabilitation Facilities Act, a
11socio-development component rate equal to 6.6% of the
12facility's nursing component rate as of January 1, 2006 shall
13be established and paid effective July 1, 2006. The
14socio-development component of the rate shall be increased by a
15factor of 2.53 on the first day of the month that begins at
16least 45 days after January 11, 2008 (the effective date of
17Public Act 95-707). As of August 1, 2008, the socio-development
18component rate shall be equal to 6.6% of the facility's nursing
19component rate as of January 1, 2006, multiplied by a factor of
203.53. For services provided on or after April 1, 2011, or the
21first day of the month that begins at least 45 days after the
22effective date of this amendatory Act of the 96th General
23Assembly, whichever is later, the Illinois Department may by
24rule adjust these socio-development component rates, and may
25use different adjustment methodologies for those facilities
26participating, and those not participating, in the Illinois

 

 

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1Department's demonstration program pursuant to the provisions
2of Title 77, Part 300, Subpart T of the Illinois Administrative
3Code, but in no case may such rates be diminished below those
4in effect on August 1, 2008.
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 as long-term care
8facilities for residents under 22 years of age, the rates
9taking effect on July 1, 2003 shall include a statewide
10increase of 4%, as defined by the Department.
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 the first day of
15the month that begins at least 45 days after the effective date
16of this amendatory Act of the 95th General Assembly shall
17include a statewide increase of 2.5%, as defined by the
18Department.
19    Notwithstanding any other provision of this Section, for
20facilities licensed by the Department of Public Health under
21the Nursing Home Care Act as skilled nursing facilities or
22intermediate care facilities, effective January 1, 2005,
23facility rates shall be increased by the difference between (i)
24a facility's per diem property, liability, and malpractice
25insurance costs as reported in the cost report filed with the
26Department of Public Aid and used to establish rates effective

 

 

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1July 1, 2001 and (ii) those same costs as reported in the
2facility's 2002 cost report. These costs shall be passed
3through to the facility without caps or limitations, except for
4adjustments required under normal auditing procedures.
5    Rates established effective each July 1 shall govern
6payment for services rendered throughout that fiscal year,
7except that rates established on July 1, 1996 shall be
8increased by 6.8% for services provided on or after January 1,
91997. Such rates will be based upon the rates calculated for
10the year beginning July 1, 1990, and for subsequent years
11thereafter until June 30, 2001 shall be based on the facility
12cost reports for the facility fiscal year ending at any point
13in time during the previous calendar year, updated to the
14midpoint of the rate year. The cost report shall be on file
15with the Department no later than April 1 of the current rate
16year. Should the cost report not be on file by April 1, the
17Department shall base the rate on the latest cost report filed
18by each skilled care facility and intermediate care facility,
19updated to the midpoint of the current rate year. In
20determining rates for services rendered on and after July 1,
211985, fixed time shall not be computed at less than zero. The
22Department shall not make any alterations of regulations which
23would reduce any component of the Medicaid rate to a level
24below what that component would have been utilizing in the rate
25effective on July 1, 1984.
26    (2) Shall take into account the actual costs incurred by

 

 

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

 

 

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1Section, "exceptional needs" means, but need not be limited to,
2ventilator care, tracheotomy care, bariatric care, complex
3wound care, and traumatic brain injury care. The enhanced
4payments for exceptional need residents under this paragraph
5are not due and payable, however, until (i) the methodologies
6described in this paragraph are approved by the federal
7government in an appropriate State Plan amendment and (ii) the
8assessment imposed by Section 5B-2 of this Code is determined
9to be a permissible tax under Title XIX of the Social Security
10Act.
11    (5) Beginning July 1, 2012 the methodologies for
12reimbursement of nursing facility services as provided under
13this Section 5-5.4 shall no longer be applicable for bills
14payable for State fiscal years 2012 and thereafter.
15    (6) No payment increase under this Section for the MDS
16methodology, exceptional care residents, or the
17socio-development component rate established by Public Act
1896-1530 of the 96th General Assembly and funded by the
19assessment imposed under Section 5B-2 of this Code shall be due
20and payable until after the Department notifies the long-term
21care providers, in writing, that the payment methodologies to
22long-term care providers required under this Section have been
23approved by the Centers for Medicare and Medicaid Services of
24the U.S. Department of Health and Human Services and the
25waivers under 42 CFR 433.68 for the assessment imposed by this
26Section, if necessary, have been granted by the Centers for

 

 

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1Medicare and Medicaid Services of the U.S. Department of Health
2and Human Services. Upon notification to the Department of
3approval of the payment methodologies required under this
4Section and the waivers granted under 42 CFR 433.68, all
5increased payments otherwise due under this Section prior to
6the date of notification shall be due and payable within 90
7days of the date federal approval is received.
8(Source: P.A. 96-45, eff. 7-15-09; 96-339, eff. 7-1-10; 96-959,
9eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1530, eff. 2-16-11;
1097-10, eff. 6-14-11; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12;
1197-584, eff. 8-26-11; revised 10-4-11.)