Sen. Heather A. Steans

Filed: 3/10/2011

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1667

2    AMENDMENT NO. ______. Amend Senate Bill 1667 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.4 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 MR/DD
16Community Care Act or the Nursing Home Care Act as Intermediate

 

 

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1Care for the Developmentally Disabled facilities, Long Term
2Care for Under Age 22 facilities, Skilled Nursing facilities,
3or Intermediate Care facilities under the medical assistance
4program shall be prospectively established annually on the
5basis of historical, financial, and statistical data
6reflecting actual costs from prior years, which shall be
7applied to the current rate year and updated for inflation,
8except that the capital cost element for newly constructed
9facilities shall be based upon projected budgets. The annually
10established payment rate shall take effect on July 1 in 1984
11and subsequent years. No rate increase and no update for
12inflation shall be provided on or after July 1, 1994 and before
13July 1, 2012, unless specifically provided for in this Section.
14The changes made by Public Act 93-841 extending the duration of
15the prohibition against a rate increase or update for inflation
16are effective retroactive to July 1, 2004.
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, 1998
21shall include an increase of 3%. For facilities licensed by the
22Department of Public Health under the Nursing Home Care Act as
23Skilled Nursing facilities or Intermediate Care facilities,
24the rates taking effect on July 1, 1998 shall include an
25increase of 3% plus $1.10 per resident-day, as defined by the
26Department. For facilities licensed by the Department of Public

 

 

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1Health under the Nursing Home Care Act as Intermediate Care
2Facilities for the Developmentally Disabled or Long Term Care
3for Under Age 22 facilities, the rates taking effect on January
41, 2006 shall include an increase of 3%. For facilities
5licensed by the Department of Public Health under the Nursing
6Home Care Act as Intermediate Care Facilities for the
7Developmentally Disabled or Long Term Care for Under Age 22
8facilities, the rates taking effect on January 1, 2009 shall
9include an increase sufficient to provide a $0.50 per hour wage
10increase for non-executive staff.
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, 1999
15shall include an increase of 1.6% plus $3.00 per resident-day,
16as defined by the Department. For facilities licensed by the
17Department of Public Health under the Nursing Home Care Act as
18Skilled Nursing facilities or Intermediate Care facilities,
19the rates taking effect on July 1, 1999 shall include an
20increase of 1.6% and, for services provided on or after October
211, 1999, shall be increased by $4.00 per resident-day, as
22defined by the Department.
23    For facilities licensed by the Department of Public Health
24under the Nursing Home Care Act as Intermediate Care for the
25Developmentally Disabled facilities or Long Term Care for Under
26Age 22 facilities, the rates taking effect on July 1, 2000

 

 

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1shall include an increase of 2.5% per resident-day, as defined
2by the Department. For facilities licensed by the Department of
3Public Health under the Nursing Home Care Act as Skilled
4Nursing facilities or Intermediate Care facilities, the rates
5taking effect on July 1, 2000 shall include an increase of 2.5%
6per resident-day, as defined by the Department.
7    For facilities licensed by the Department of Public Health
8under the Nursing Home Care Act as skilled nursing facilities
9or intermediate care facilities, a new payment methodology must
10be implemented for the nursing component of the rate effective
11July 1, 2003. The Department of Public Aid (now Healthcare and
12Family Services) shall develop the new payment methodology
13using the Minimum Data Set (MDS) as the instrument to collect
14information concerning nursing home resident condition
15necessary to compute the rate. The Department shall develop the
16new payment methodology to meet the unique needs of Illinois
17nursing home residents while remaining subject to the
18appropriations provided by the General Assembly. A transition
19period from the payment methodology in effect on June 30, 2003
20to the payment methodology in effect on July 1, 2003 shall be
21provided for a period not exceeding 3 years and 184 days after
22implementation of the new payment methodology as follows:
23        (A) For a facility that would receive a lower nursing
24    component rate per patient day under the new system than
25    the facility received effective on the date immediately
26    preceding the date that the Department implements the new

 

 

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1    payment methodology, the nursing component rate per
2    patient day for the facility shall be held at the level in
3    effect on the date immediately preceding the date that the
4    Department implements the new payment methodology until a
5    higher nursing component rate of reimbursement is achieved
6    by that facility.
7        (B) For a facility that would receive a higher nursing
8    component rate per patient day under the payment
9    methodology in effect on July 1, 2003 than the facility
10    received effective on the date immediately preceding the
11    date that the Department implements the new payment
12    methodology, the nursing component rate per patient day for
13    the facility shall be adjusted.
14        (C) Notwithstanding paragraphs (A) and (B), the
15    nursing component rate per patient day for the facility
16    shall be adjusted subject to appropriations provided by the
17    General Assembly.
18    For facilities licensed by the Department of Public Health
19under the Nursing Home Care Act as Intermediate Care for the
20Developmentally Disabled facilities or Long Term Care for Under
21Age 22 facilities, the rates taking effect on March 1, 2001
22shall include a statewide increase of 7.85%, as defined by the
23Department.
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, except facilities participating
2in the Department's demonstration program pursuant to the
3provisions of Title 77, Part 300, Subpart T of the Illinois
4Administrative Code, the numerator of the ratio used by the
5Department of Healthcare and Family Services to compute the
6rate payable under this Section using the Minimum Data Set
7(MDS) methodology shall incorporate the following annual
8amounts as the additional funds appropriated to the Department
9specifically to pay for rates based on the MDS nursing
10component methodology in excess of the funding in effect on
11December 31, 2006:
12        (i) For rates taking effect January 1, 2007,
13    $60,000,000.
14        (ii) For rates taking effect January 1, 2008,
15    $110,000,000.
16        (iii) For rates taking effect January 1, 2009,
17    $194,000,000.
18        (iv) For rates taking effect April 1, 2011, or the
19    first day of the month that begins at least 45 days after
20    the effective date of this amendatory Act of the 96th
21    General Assembly, $416,500,000 or an amount as may be
22    necessary to complete the transition to the MDS methodology
23    for the nursing component of the rate.
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, a
10socio-development component rate equal to 6.6% of the
11facility's nursing component rate as of January 1, 2006 shall
12be established and paid effective July 1, 2006. The
13socio-development component of the rate shall be increased by a
14factor of 2.53 on the first day of the month that begins at
15least 45 days after January 11, 2008 (the effective date of
16Public Act 95-707). As of August 1, 2008, the socio-development
17component rate shall be equal to 6.6% of the facility's nursing
18component rate as of January 1, 2006, multiplied by a factor of
193.53. For services provided on or after April 1, 2011, or the
20first day of the month that begins at least 45 days after the
21effective date of this amendatory Act of the 96th General
22Assembly, whichever is later, the Illinois Department may by
23rule adjust these socio-development component rates, and may
24use different adjustment methodologies for those facilities
25participating, and those not participating, in the Illinois
26Department's demonstration program pursuant to the provisions

 

 

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1of Title 77, Part 300, Subpart T of the Illinois Administrative
2Code, but in no case may such rates be diminished below those
3in effect on August 1, 2008.
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 as long-term care
7facilities for residents under 22 years of age, the rates
8taking effect on July 1, 2003 shall include a statewide
9increase of 4%, as defined by the Department.
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 the first day of
14the month that begins at least 45 days after the effective date
15of this amendatory Act of the 95th General Assembly shall
16include a statewide increase of 2.5%, 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, effective January 1, 2005,
22facility rates shall be increased by the difference between (i)
23a facility's per diem property, liability, and malpractice
24insurance costs as reported in the cost report filed with the
25Department of Public Aid and used to establish rates effective
26July 1, 2001 and (ii) those same costs as reported in the

 

 

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1facility's 2002 cost report. These costs shall be passed
2through to the facility without caps or limitations, except for
3adjustments required under normal auditing procedures.
4    Rates established effective each July 1 shall govern
5payment for services rendered throughout that fiscal year,
6except that rates established on July 1, 1996 shall be
7increased by 6.8% for services provided on or after January 1,
81997. Such rates will be based upon the rates calculated for
9the year beginning July 1, 1990, and for subsequent years
10thereafter until June 30, 2001 shall be based on the facility
11cost reports for the facility fiscal year ending at any point
12in time during the previous calendar year, updated to the
13midpoint of the rate year. The cost report shall be on file
14with the Department no later than April 1 of the current rate
15year. Should the cost report not be on file by April 1, the
16Department shall base the rate on the latest cost report filed
17by each skilled care facility and intermediate care facility,
18updated to the midpoint of the current rate year. In
19determining rates for services rendered on and after July 1,
201985, fixed time shall not be computed at less than zero. The
21Department shall not make any alterations of regulations which
22would reduce any component of the Medicaid rate to a level
23below what that component would have been utilizing in the rate
24effective on July 1, 1984.
25    (2) Shall take into account the actual costs incurred by
26facilities in providing services for recipients of skilled

 

 

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1nursing and intermediate care services under the medical
2assistance program.
3    (3) Shall take into account the medical and psycho-social
4characteristics and needs of the patients.
5    (4) Shall take into account the actual costs incurred by
6facilities in meeting licensing and certification standards
7imposed and prescribed by the State of Illinois, any of its
8political subdivisions or municipalities and by the U.S.
9Department of Health and Human Services pursuant to Title XIX
10of the Social Security Act.
11    The Department of Healthcare and Family Services shall
12develop precise standards for payments to reimburse nursing
13facilities for any utilization of appropriate rehabilitative
14personnel for the provision of rehabilitative services which is
15authorized by federal regulations, including reimbursement for
16services provided by qualified therapists or qualified
17assistants, and which is in accordance with accepted
18professional practices. Reimbursement also may be made for
19utilization of other supportive personnel under appropriate
20supervision.
21    The Department shall develop enhanced payments to offset
22the additional costs incurred by a facility serving exceptional
23need residents and shall allocate at least $8,000,000 of the
24funds collected from the assessment established by Section 5B-2
25of this Code for such payments. For the purpose of this
26Section, "exceptional needs" means, but need not be limited to,

 

 

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1ventilator care, tracheotomy care, bariatric care, complex
2wound care, and traumatic brain injury care.
3    (5) Beginning July 1, 2012 the methodologies for
4reimbursement of nursing facility services as provided under
5this Section 5-5.4 shall no longer be applicable for bills
6payable for State fiscal years 2012 and thereafter.
7(Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707,
8eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09;
996-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10;
1096-1530, eff. 2-16-11.)".