Illinois General Assembly - Full Text of HB4678
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Full Text of HB4678  102nd General Assembly

HB4678 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB4678

 

Introduced 1/21/2022, by Rep. Anna Moeller

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Nurse Agency Licensing Act. Prohibits nurse agencies from entering into covenants not to compete with nurses and certified nurse aides who are employed by the agencies. Provides that a supplemental healthcare staffing agency must not bill nor receive payments from a licensed health care facility at a rate higher than 130% of the sum of total compensation plus associated payroll taxes for applicable employee classifications. Provides that the maximum charge must include all charges for administrative fees, contract fees, or other special charges in addition to compensation for the temporary nursing pool personnel supplied to a health care facility. Amends the Illinois Public Aid Code. Provides that is shall be a matter of State policy that the Department of Healthcare and Family Services shall set nursing facility rates, by rule, utilizing an evidence-based methodology that rewards appropriate staffing, quality-of-life improvements for nursing facility residents, and the reduction of racial inequities and health disparities for nursing facility residents enrolled in Medicaid. Contains provisions concerning the Patient Driven Payment Model for nursing services reimbursements; utilization of the Staff Time and Resource Intensity Verification study; the statewide base rate for certain dates of service; the establishment of a variable per diem add-on for nursing facilities with specified staffing levels; directed payments to improve the quality of care delivered by nursing facilities; occupied bed tax amounts beginning January 1, 2022, emergency rules; and other matters. Schedules for repeal on July 1, 2024 the Nursing Home License Fee Article of the Code. Amends the Illinois Administrative Procedure Act. Permits the Department of Healthcare and Family Services to adopt emergency rules to implement certain changes made by the amendatory Act. Effective immediately.


LRB102 24964 KTG 34219 b

 

 

A BILL FOR

 

HB4678LRB102 24964 KTG 34219 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 Administrative Procedure Act is
5amended by adding Section 5-45.21 as follows:
 
6    (5 ILCS 100/5-45.21 new)
7    Sec. 5-45.21. Emergency rulemaking; Department of
8Healthcare and Family Services. To provide for the expeditious
9and timely implementation of changes made to Section 5-5.2 of
10the Illinois Public Aid Code by this amendatory Act of the
11102nd General Assembly, emergency rules implementing the such
12changes may be adopted in accordance with Section 5-45 by the
13Department of Healthcare and Family Services. The adoption of
14emergency rules authorized by Section 5-45 and this Section is
15deemed to be necessary for the public interest, safety, and
16welfare.
17    This Section is repealed one year after the effective date
18of this amendatory Act of the 102nd General Assembly.
 
19    Section 10. The Nurse Agency Licensing Act is amended by
20changing Sections 3 and 14 as follows:
 
21    (225 ILCS 510/3)  (from Ch. 111, par. 953)

 

 

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1    Sec. 3. Definitions. As used in this Act:
2    (a) "Certified nurse aide" means an individual certified
3as defined in Section 3-206 of the Nursing Home Care Act,
4Section 3-206 of the ID/DD Community Care Act, or Section
53-206 of the MC/DD Act, as now or hereafter amended.
6    (b) "Department" means the Department of Labor.
7    (c) "Director" means the Director of Labor.
8    (d) "Health care facility" is defined as in Section 3 of
9the Illinois Health Facilities Planning Act, as now or
10hereafter amended.
11    (e) "Licensee" means any nursing agency which is properly
12licensed under this Act.
13    (f) "Nurse" means a registered nurse or a licensed
14practical nurse as defined in the Nurse Practice Act.
15    (g) "Nurse agency" means any individual, firm,
16corporation, partnership or other legal entity that employs,
17assigns or refers nurses or certified nurse aides to a health
18care facility for a fee. The term "nurse agency" includes
19nurses registries. The term "nurse agency" does not include
20services provided by home health agencies licensed and
21operated under the Home Health, Home Services, and Home
22Nursing Agency Licensing Act or a licensed or certified
23individual who provides his or her own services as a regular
24employee of a health care facility, nor does it apply to a
25health care facility's organizing nonsalaried employees to
26provide services only in that facility.

 

 

HB4678- 3 -LRB102 24964 KTG 34219 b

1    (h) "Covenant not to compete" means an agreement between
2an employer and an employee that restricts such employee from
3performing:
4        (1) any work for another employer for a specified
5    period of time;
6        (2) any work in a specified geographical area; or
7        (3) work for another employer that is similar to such
8    employee's work for the employer included as a party to
9    the agreement.
10(Source: P.A. 98-104, eff. 7-22-13; 99-180, eff. 7-29-15.)
 
11    (225 ILCS 510/14)  (from Ch. 111, par. 964)
12    Sec. 14. Minimum Standards. (a) The Department, by rule,
13shall establish minimum standards for the operation of nurse
14agencies. Those standards shall include, but are not limited
15to: (1) the maintenance of written policies and procedures;
16and (2) the development of personnel policies which include a
17personal interview, a reference check, an annual evaluation of
18each employee (which may be based in part upon information
19provided by health care facilities utilizing nurse agency
20personnel) and periodic health examinations.
21    (b) Each nurse agency shall have a nurse serving as a
22manager or supervisor of all nurses and certified nurses
23aides.
24    (c) Each nurse agency shall ensure that its employees meet
25the minimum licensing, training, and orientation standards for

 

 

HB4678- 4 -LRB102 24964 KTG 34219 b

1which those employees are licensed or certified.
2    (d) A nurse agency shall not employ, assign, or refer for
3use in an Illinois health care facility a nurse or certified
4nurse aide unless certified or licensed under applicable
5provisions of State and federal law or regulations. Each
6certified nurse aide shall comply with all pertinent
7regulations of the Illinois Department of Public Health
8relating to the health and other qualifications of personnel
9employed in health care facilities.
10    (e) The Department may adopt rules to monitor the usage of
11nurse agency services to determine their impact.
12    (f) Nurse agencies are prohibited from requiring, as a
13condition of employment, assignment, or referral, that their
14employees recruit new employees for the nurse agency from
15among the permanent employees of the health care facility to
16which the nurse agency employees have been employed, assigned,
17or referred, and the health care facility to which such
18employees are employed, assigned, or referred is prohibited
19from requiring, as a condition of employment, that their
20employees recruit new employees from these nurse agency
21employees. Violation of this provision is a business offense.
22    (g) Nurse agencies are prohibited from entering into
23covenants not to compete with nurses and certified nurse aides
24who are employed by the agencies. After the effective date of
25this amendatory Act of the 102nd General Assembly, a covenant
26not to compete entered into between a nurse agency and a

 

 

HB4678- 5 -LRB102 24964 KTG 34219 b

1certified nurse aide is illegal and void.
2    (h) Maximum charges. A supplemental healthcare staffing
3agency must not bill nor receive payments from a health care
4facility licensed by the State at a rate higher than 130% of
5the sum of total compensation plus associated payroll taxes
6for applicable employee classifications. Agencies must submit
7a confidential report to the Department of Employment Security
8on a quarterly basis the sum of total compensation plus
9associated payroll taxes for all applicable employee
10classifications, and shall separately include in this report
11the total revenue received from health care facilities
12licensed by the State for the same period for these employees,
13thereby enabling the Department's calculation of the ratio of
14these 2 totals. This ratio shall be used by the Department to
15determine compliance with this maximum charge provision, and
16the veracity of the underlying data shall be subject to audit
17by the Department as well as by the Auditor General. For
18purposes of this subsection, total compensation shall include,
19at a minimum, wages defined as hourly rate of pay and shift
20differential, including weekend shift differential and
21overtime.
22    The maximum charge must include all charges for
23administrative fees, contract fees, or other special charges
24in addition to compensation for the temporary nursing pool
25personnel supplied to a health care facility. A health care
26facility that pays for the actual travel and housing costs for

 

 

HB4678- 6 -LRB102 24964 KTG 34219 b

1supplemental healthcare staffing agency staff working at the
2facility and that pays these costs to the employee, the
3agency, or another vendor, is not required to count these
4costs as total compensation.
5(Source: P.A. 86-817.)
 
6    Section 15. The Illinois Public Aid Code is amended by
7changing Sections 5-5.2, 5B-2, 5B-4, 5B-5, 5B-8, 5E-10, and by
8adding Section 5E-20 as follows:
 
9    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
10    Sec. 5-5.2. Payment.
11    (a) All nursing facilities that are grouped pursuant to
12Section 5-5.1 of this Act shall receive the same rate of
13payment for similar services.
14    (b) It shall be a matter of State policy that the Illinois
15Department shall utilize a uniform billing cycle throughout
16the State for the long-term care providers.
17    (b-1) It shall be a matter of State policy that the
18Department shall set nursing facility rates, by rule,
19utilizing an evidence-based methodology that rewards
20appropriate staffing, quality-of-life improvements for nursing
21facility residents, and the reduction of racial inequities and
22health disparities for nursing facility residents enrolled in
23Medicaid.
24    (c) (Blank). Notwithstanding any other provisions of this

 

 

HB4678- 7 -LRB102 24964 KTG 34219 b

1Code, the methodologies for reimbursement of nursing services
2as provided under this Article shall no longer be applicable
3for bills payable for nursing services rendered on or after a
4new reimbursement system based on the Resource Utilization
5Groups (RUGs) has been fully operationalized, which shall take
6effect for services provided on or after January 1, 2014.
7    (d) The new nursing services reimbursement methodology
8utilizing the Patient Driven Payment Model RUG-IV 48 grouper
9model, which shall be referred to as the PDPM RUGs
10reimbursement system, taking effect January 1, 2022, upon
11federal approval by the Centers for Medicare and Medicaid
12Services 2014, shall be based on the following:
13        (1) The methodology shall be resident-centered
14    resident-driven, facility-specific, and based on guidance
15    from the Centers for Medicare and Medicaid Services
16    cost-based.
17        (2) Costs shall be annually rebased and case mix index
18    quarterly updated. The nursing services methodology will
19    be assigned to the Medicaid enrolled residents on record
20    as of 30 days prior to the beginning of the rate period in
21    the Department's Medicaid Management Information System
22    (MMIS) as present on the last day of the second quarter
23    preceding the rate period based upon the Assessment
24    Reference Date of the Minimum Data Set (MDS).
25        (3) Regional wage adjustors based on the Health
26    Service Areas (HSA) groupings and adjusters in effect on

 

 

HB4678- 8 -LRB102 24964 KTG 34219 b

1    January 1, 2022 April 30, 2012 shall be included, except
2    no adjuster shall be lower than 1.0.
3        (4) PDPM nursing case-mix indices in effect on May 1,
4    2021 Case mix index shall be assigned to each resident
5    class based on the Centers for Medicare and Medicaid
6    Services staff time measurement study called Staff Time
7    and Resource Intensity Verification (STRIVE) in effect on
8    July 1, 2013, adjusted by a uniform multiplier to achieve
9    the same statewide case mix index value observed for the
10    quarter beginning April 1, 2021 while holding PA1, PA2,
11    BA1, and BB1 resident classes at the level applicable
12    under the RUG-IV payment model prior to January 1, 2022
13    utilizing an index maximization approach.
14        (5) (Blank). The pool of funds available for
15    distribution by case mix and the base facility rate shall
16    be determined using the formula contained in subsection
17    (d-1).
18        (6) The statewide base rate for dates of service
19    before January 1, 2022 shall be $85.25, and thereafter
20    shall be no less than $90.25.
21        (7) The Department shall establish a variable per diem
22    add-on based on information from the most recent available
23    federal staffing report, currently the Payroll Based
24    Journal, adjusted for acuity if applicable using the same
25    quarter's MDS. The variable per diem add-on shall be paid
26    only to facilities with at least 70% of the staffing

 

 

HB4678- 9 -LRB102 24964 KTG 34219 b

1    indicated by the STRIVE study. For facilities at 70% of
2    the staffing indicated by the STRIVE study, those
3    facilities shall be paid a per diem add-on of $9,
4    increasing by equivalent steps for each whole percentage
5    point of improvement until the facilities reach a per diem
6    of $14.88. For facilities with at least 80% of the
7    staffing indicated by the STRIVE study, those facilities
8    shall be paid a per diem add-on of $14.88, increasing by
9    equivalent steps for each whole percentage point of
10    improvement until the facilities reach a per diem add-on
11    of $23.80. For facilities with at least 92% of the
12    staffing indicated by the STRIVE study, those facilities
13    shall be paid a per diem add-on of $23.80, increasing by
14    equivalent steps for each whole percentage point of
15    improvement until the facilities reach a per diem add-on
16    of $29.75. For facilities with at least 100% of the
17    staffing indicated by the STRIVE study, those facilities
18    shall be paid a per diem add-on of $29.75, increasing by
19    equivalent steps for each whole percentage point of
20    improvement until the facilities reach a per diem add-on
21    of $35.70. For facilities with at least 110% of the
22    staffing indicated by the STRIVE study, those facilities
23    shall be paid a per diem add-on of $35.70, increasing by
24    equivalent steps for each whole percentage point of
25    improvement until the facilities reach a per diem add-on
26    of $38.68. For facilities with 125% of the staffing

 

 

HB4678- 10 -LRB102 24964 KTG 34219 b

1    indicated by the STRIVE study or more, those facilities
2    shall be paid a per diem add-on of $38.68. The Department
3    shall establish, by rule, a limit of not more than a 5
4    percentage point drop per once-consecutive quarter in the
5    STRIVE percentage used to determine the variable per diem
6    add-on.
7    (d-1) (Blank). Calculation of base year Statewide RUG-IV
8nursing base per diem rate.
9        (1) Base rate spending pool shall be:
10            (A) The base year resident days which are
11        calculated by multiplying the number of Medicaid
12        residents in each nursing home as indicated in the MDS
13        data defined in paragraph (4) by 365.
14            (B) Each facility's nursing component per diem in
15        effect on July 1, 2012 shall be multiplied by
16        subsection (A).
17            (C) Thirteen million is added to the product of
18        subparagraph (A) and subparagraph (B) to adjust for
19        the exclusion of nursing homes defined in paragraph
20        (5).
21        (2) For each nursing home with Medicaid residents as
22    indicated by the MDS data defined in paragraph (4),
23    weighted days adjusted for case mix and regional wage
24    adjustment shall be calculated. For each home this
25    calculation is the product of:
26            (A) Base year resident days as calculated in

 

 

HB4678- 11 -LRB102 24964 KTG 34219 b

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

 

 

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1    subsection. The data from these facilities shall not be
2    used in the computations described in paragraphs (1)
3    through (4) above to establish the base rate.
4    (e) Beginning July 1, 2014 through December 31, 2021, the
5Department shall allocate funding in the amount up to
6$10,000,000 for per diem add-ons to the RUGS methodology for
7dates of service on and after July 1, 2014:
8        (1) $0.63 for each resident who scores in I4200
9    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
10        (2) $2.67 for each resident who scores either a "1" or
11    "2" in any items S1200A through S1200I and also scores in
12    RUG groups PA1, PA2, BA1, or BA2.
13        (3) Beginning on January 1, 2022, the Department shall
14    allocate funding, by rule, for per diem add-ons to the
15    PDPM methodology for each resident with a diagnosis of
16    Alzheimer's disease.
17    (e-1) (Blank).
18    (e-2) (Blank). For dates of services beginning January 1,
192014, the RUG-IV nursing component per diem for a nursing home
20shall be the product of the statewide RUG-IV nursing base per
21diem rate, the facility average case mix index, and the
22regional wage adjustor. Transition rates for services provided
23between January 1, 2014 and December 31, 2014 shall be as
24follows:
25        (1) The transition RUG-IV per diem nursing rate for
26    nursing homes whose rate calculated in this subsection

 

 

HB4678- 13 -LRB102 24964 KTG 34219 b

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

 

 

HB4678- 14 -LRB102 24964 KTG 34219 b

1and after July 1, 2012, for facilities not designated by the
2Department of Healthcare and Family Services as "Institutions
3for Mental Disease", rates effective May 1, 2011 shall be
4adjusted as follows:
5        (1) (Blank); Individual nursing rates for residents
6    classified in RUG IV groups PA1, PA2, BA1, and BA2 during
7    the quarter ending March 31, 2012 shall be reduced by 10%;
8        (2) (Blank); Individual nursing rates for residents
9    classified in all other RUG IV groups shall be reduced by
10    1.0%;
11        (3) Facility rates for the capital and support
12    components shall be reduced by 1.7%.
13    (h) Notwithstanding any other provision of this Code, on
14and after July 1, 2012, nursing facilities designated by the
15Department of Healthcare and Family Services as "Institutions
16for Mental Disease" and "Institutions for Mental Disease" that
17are facilities licensed under the Specialized Mental Health
18Rehabilitation Act of 2013 shall have the nursing,
19socio-developmental, capital, and support components of their
20reimbursement rate effective May 1, 2011 reduced in total by
212.7%.
22    (i) On and after July 1, 2014, the reimbursement rates for
23the support component of the nursing facility rate for
24facilities licensed under the Nursing Home Care Act as skilled
25or intermediate care facilities shall be the rate in effect on
26June 30, 2014 increased by 8.17%.

 

 

HB4678- 15 -LRB102 24964 KTG 34219 b

1    (j) Notwithstanding any other provision of law, subject to
2federal approval, effective July 1, 2019, sufficient funds
3shall be allocated for changes to rates for facilities
4licensed under the Nursing Home Care Act as skilled nursing
5facilities or intermediate care facilities for dates of
6services on and after July 1, 2019: (i) to establish, through
7December 31, 2021 or upon implementation of the variable per
8diem add-on for staffing under paragraph (7) of subsection
9(d), whichever is later, a per diem add-on to the direct care
10per diem rate not to exceed $70,000,000 annually in the
11aggregate taking into account federal matching funds for the
12purpose of addressing the facility's unique staffing needs,
13adjusted quarterly and distributed by a weighted formula based
14on Medicaid bed days on the last day of the second quarter
15preceding the quarter for which the rate is being adjusted.
16Beginning January 1, 2022, or upon implementation of the
17variable per diem add-on for staffing under paragraph (7) of
18subsection (d), whichever is later, the annual $70,000,000
19described in the preceding sentence shall be dedicated to the
20variable per diem add-on for staffing under paragraph (7) of
21subsection (d); and (ii) in an amount not to exceed
22$170,000,000 annually in the aggregate taking into account
23federal matching funds to permit the support component of the
24nursing facility rate to be updated as follows:
25        (1) 80%, or $136,000,000, of the funds shall be used
26    to update each facility's rate in effect on June 30, 2019

 

 

HB4678- 16 -LRB102 24964 KTG 34219 b

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    In order to provide for the expeditious and timely
15implementation of the provisions of this amendatory Act of the
16102nd General Assembly, emergency rules to implement any
17provision of this amendatory Act of the 102nd General Assembly
18may be adopted in accordance with this subsection by the
19agency charged with administering that provision or
20initiative. The 24-month limitation on the adoption of
21emergency rules does not apply to rules adopted under this
22subsection. The adoption of emergency rules authorized by this
23subsection is deemed to be necessary for the public interest,
24safety, and welfare.
25    To implement item (i) in this subsection, facilities shall
26file quarterly reports documenting compliance with its

 

 

HB4678- 17 -LRB102 24964 KTG 34219 b

1annually approved staffing plan, which shall permit compliance
2with Section 3-202.05 of the Nursing Home Care Act. A facility
3that fails to meet the benchmarks and dates contained in the
4plan may have its add-on adjusted in the quarter following the
5quarterly review. Nothing in this Section shall limit the
6ability of the facility to appeal a ruling of non-compliance
7and a subsequent reduction to the add-on. Funds adjusted for
8noncompliance shall be maintained in the Long-Term Care
9Provider Fund and accounted for separately. At the end of each
10fiscal year, these funds shall be made available to facilities
11for special staffing projects.
12    In order to provide for the expeditious and timely
13implementation of the provisions of Public Act 101-10,
14emergency rules to implement any provision of Public Act
15101-10 may be adopted in accordance with this subsection by
16the agency charged with administering that provision or
17initiative. The agency shall simultaneously file emergency
18rules and permanent rules to ensure that there is no
19interruption in administrative guidance. The 150-day
20limitation of the effective period of emergency rules does not
21apply to rules adopted under this subsection, and the
22effective period may continue through June 30, 2021. The
2324-month limitation on the adoption of emergency rules does
24not apply to rules adopted under this subsection. The adoption
25of emergency rules authorized by this subsection is deemed to
26be necessary for the public interest, safety, and welfare.

 

 

HB4678- 18 -LRB102 24964 KTG 34219 b

1    (k) During the first quarter of State Fiscal Year 2020,
2the Department of Healthcare of Family Services must convene a
3technical advisory group consisting of members of all trade
4associations representing Illinois skilled nursing providers
5to discuss changes necessary with federal implementation of
6Medicare's Patient-Driven Payment Model. Implementation of
7Medicare's Patient-Driven Payment Model shall, by September 1,
82020, end the collection of the MDS data that is necessary to
9maintain the current RUG-IV Medicaid payment methodology. The
10technical advisory group must consider a revised reimbursement
11methodology that takes into account transparency,
12accountability, actual staffing as reported under the
13federally required Payroll Based Journal system, changes to
14the minimum wage, adequacy in coverage of the cost of care, and
15a quality component that rewards quality improvements.
16    (l) The Department shall establish directed payments to
17improve the quality of care delivered by facilities,
18including:
19        (1) Incentive payments determined by facility
20    performance on specified quality measures in an initial
21    amount of $70,000,000. Nothing in this Section shall be
22    construed to limit the quality of care directed payments
23    to $70,000,000, and in the case that quality of care has
24    improved across nursing facilities, the Department shall
25    adjust those directed payments accordingly. The quality
26    payment methodology described in this Section must be used

 

 

HB4678- 19 -LRB102 24964 KTG 34219 b

1    for at least the first 2 quarters in calendar year 2022.
2    Beginning with the quarter starting July 1, 2022, the
3    Department may add, remove, or change quality metrics and
4    make associated changes to the quality payment methodology
5    as outlined in subparagraph (E). Facilities designated by
6    the Centers for Medicare and Medicaid Services as a
7    special focus facility or a hospital-based nursing home do
8    not qualify for quality payments.
9            (A) Each quality pool must be distributed by
10        assigning a quality weighted score for each nursing
11        home which is calculated by multiplying the nursing
12        home's quality base period Medicaid days by the
13        nursing home's star rating weight in that period.
14            (B) Star rating weights are assigned based on the
15        nursing home's star rating for the LTS quality star
16        rating. "LTS quality star rating" means the long stay
17        quality rating for each nursing facility as assigned
18        by the Centers for Medicare and Medicaid Services
19        under the Five-Star Quality Rating System. The rating
20        is a number ranging from 0 (lowest) to 5 (highest).
21                (i) Zero or one star rating has a weight of 0.
22                (ii) Two star rating has a weight of 0.75.
23                (iii) Three star rating has a weight of 1.5.
24                (iv) Four star rating has a weight of 2.5.
25                (v) Five star rating has a weight of 3.5.
26            (C) Each nursing home's quality weight score is

 

 

HB4678- 20 -LRB102 24964 KTG 34219 b

1        divided by the sum of all quality weight scores for
2        qualifying nursing homes to determine the proportion
3        of the quality pool to be paid to the nursing home.
4            (D) The quality pool is no less than $70,000,000
5        annually or $17,500,000 per quarter.
6            (E) The Department shall review quality metrics
7        used for payment of the quality pool and make
8        recommendations for any associated changes to the
9        methodology for distributing quality pool payments to
10        a quality review committee established by the
11        Department consisting of associations representing
12        long-term care providers, consumer advocates,
13        organizations representing workers of long-term care
14        facilities, and payors.
15            (F) The Department shall disburse quality pool
16        payments from the Long-Term Care Provider Fund on
17        either a monthly or daily basis in amounts
18        proportional to the total quality pool payment
19        determined for the quarter.
20            (G) The Department shall publish any changes in
21        the methodology for distributing quality pool payments
22        prior to the beginning of the measurement period, or
23        quality base period, for any metric added to the
24        distribution's methodology.
25        (2) Payments based on CNA tenure, promotion, and CNA
26    training for the purpose of increasing CNA compensation.

 

 

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1    It is the intent of this subsection that payments made in
2    accordance with this paragraph be directly incorporated
3    into increased compensation for CNAs. As used in this
4    paragraph, "CNA" means a certified nursing assistant as
5    that term is described in Section 3-206 of the Nursing
6    Home Care Act, Section 3-206 of the ID/DD Community Care
7    Act, and Section 3-206 of the MC/DD Act. The Department
8    shall establish, by rule, payments to nursing facilities
9    equal to Medicaid's share of the tenure wage increments
10    specified in this paragraph for all reported CNA employee
11    hours compensated according to a posted schedule
12    consisting of increments at least as large as those
13    specified in this paragraph. The increments are as
14    follows: an additional $1.50 per hour for CNAs with at
15    least one and less than 2 years' experience plus another
16    $1 per hour for each additional year of experience up to a
17    maximum of $6.50 for CNAs with at least 6 years of
18    experience. For purposes of this paragraph, Medicaid's
19    share shall be the ratio determined by paid Medicaid bed
20    days divided by total bed days for the applicable time
21    period used in the calculation. In addition, and additive
22    to any tenure increments paid as specified in this
23    paragraph, the Department shall establish, by rule,
24    payments supporting Medicaid's share of the
25    promotion-based wage increments for CNA employee hours
26    compensated for that promotion with at least a $1.50

 

 

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1    hourly increase. Medicaid's share shall be established as
2    it is for the tenure increments described in this
3    paragraph. Qualifying promotions shall be defined by the
4    Department in rules for an expected 10-15% subset of CNAs
5    assigned intermediate, specialized, or added roles such as
6    CNA trainers, CNA scheduling 'captains', and CNA
7    specialists for resident conditions like dementia or
8    memory care or behavioral health.
9    (m) In order to provide for the expeditious and timely
10implementation of the provisions of this amendatory Act of the
11102nd General Assembly, emergency rules to implement any
12provision of this amendatory Act of the 102nd General Assembly
13may be adopted in accordance with this subsection by the
14agency charged with administering that provision or
15initiative. The 24-month limitation on the adoption of
16emergency rules does not apply to rules adopted under this
17subsection. The adoption of emergency rules authorized by this
18subsection is deemed to be necessary for the public interest,
19safety, and welfare.
20(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
21102-77, eff. 7-9-21; 102-558, eff. 8-20-21.)
 
22    (305 ILCS 5/5B-2)  (from Ch. 23, par. 5B-2)
23    Sec. 5B-2. Assessment; no local authorization to tax.
24    (a) For the privilege of engaging in the occupation of
25long-term care provider, beginning July 1, 2011 through

 

 

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1December 31, 2021, or upon federal approval by the Centers for
2Medicare and Medicaid Services of the long-term care provider
3assessment described in subsection (a-1), whichever is later,
4an assessment is imposed upon each long-term care provider in
5an amount equal to $6.07 times the number of occupied bed days
6due and payable each month. Notwithstanding any provision of
7any other Act to the contrary, this assessment shall be
8construed as a tax, but shall not be billed or passed on to any
9resident of a nursing home operated by the nursing home
10provider.
11    (a-1) For the privilege of engaging in the occupation of
12long-term care provider, beginning January 1, 2022, an
13assessment is imposed upon each long-term care provider in an
14amount varying with the number of paid Medicaid resident days
15per annum in the facility with the following initial schedule
16of occupied bed tax amounts:
17        (1) 0-5,000 Medicaid resident days per annum, $10.67.
18        (2) 5,001-15,000 Medicaid resident days per annum,
19    $19.20.
20        (3) 15,001-35,000 Medicaid resident days per annum,
21    $22.40.
22        (4) 35,001-55,000 Medicaid resident days per annum,
23    $19.20.
24        (5) 55,001-65,000 Medicaid resident days per annum,
25    $13.86.
26        (6) 65,001+ Medicaid resident days per annum, $10.67.

 

 

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1        (7) Any nonprofit nursing facilities without
2    Medicaid-certified beds, $7 per occupied bed day.
3    Notwithstanding any provision of any other Act to the
4contrary, this assessment shall be construed as a tax but
5shall not be billed or passed on to any resident of a nursing
6home operated by the nursing home provider.
7    Each facility's paid Medicaid resident days per annum
8shall be updated annually for the purpose of determining the
9appropriate tax rate.
10    Implementation of the assessment described in this
11subsection shall be subject to federal approval by the Centers
12for Medicare and Medicaid Services.
13    (b) Nothing in this amendatory Act of 1992 shall be
14construed to authorize any home rule unit or other unit of
15local government to license for revenue or impose a tax or
16assessment upon long-term care providers or the occupation of
17long-term care provider, or a tax or assessment measured by
18the income or earnings or occupied bed days of a long-term care
19provider.
20    (c) The assessment imposed by this Section shall not be
21due and payable, however, until after the Department notifies
22the long-term care providers, in writing, that the payment
23methodologies to long-term care providers required under
24Section 5-5.2 5-5.4 of this Code have been approved by the
25Centers for Medicare and Medicaid Services of the U.S.
26Department of Health and Human Services and that the waivers

 

 

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1under 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
4Health and Human Services.
5(Source: P.A. 96-1530, eff. 2-16-11; 97-10, eff. 6-14-11;
697-584, eff. 8-26-11.)
 
7    (305 ILCS 5/5B-4)  (from Ch. 23, par. 5B-4)
8    Sec. 5B-4. Payment of assessment; penalty.
9    (a) The assessment imposed by Section 5B-2 shall be due
10and payable monthly, on the last State business day of the
11month for occupied bed days reported for the preceding third
12month prior to the month in which the tax is payable and due. A
13facility that has delayed payment due to the State's failure
14to reimburse for services rendered may request an extension on
15the due date for payment pursuant to subsection (b) and shall
16pay the assessment within 30 days of reimbursement by the
17Department. The Illinois Department may provide that county
18nursing homes directed and maintained pursuant to Section
195-1005 of the Counties Code may meet their assessment
20obligation by certifying to the Illinois Department that
21county expenditures have been obligated for the operation of
22the county nursing home in an amount at least equal to the
23amount of the assessment.
24    (a-5) The Illinois Department shall provide for an
25electronic submission process for each long-term care facility

 

 

HB4678- 26 -LRB102 24964 KTG 34219 b

1to report at a minimum the number of occupied bed days of the
2long-term care facility for the reporting period and other
3reasonable information the Illinois Department requires for
4the administration of its responsibilities under this Code.
5Beginning July 1, 2013, a separate electronic submission shall
6be completed for each long-term care facility in this State
7operated by a long-term care provider. The Illinois Department
8shall provide a self-reporting notice of the assessment form
9that the long-term care facility completes for the required
10period and submits with its assessment payment to the Illinois
11Department. To the extent practicable, the Department shall
12coordinate the assessment reporting requirements with other
13reporting required of long-term care facilities.
14    (b) The Illinois Department is authorized to establish
15delayed payment schedules for long-term care providers that
16are unable to make assessment payments when due under this
17Section due to financial difficulties, as determined by the
18Illinois Department. The Illinois Department may not deny a
19request for delay of payment of the assessment imposed under
20this Article if the long-term care provider has not been paid
21for services provided during the month on which the assessment
22is levied or the Medicaid managed care organization has not
23been paid by the State.
24    (c) If a long-term care provider fails to pay the full
25amount of an assessment payment when due (including any
26extensions granted under subsection (b)), there shall, unless

 

 

HB4678- 27 -LRB102 24964 KTG 34219 b

1waived by the Illinois Department for reasonable cause, be
2added to the assessment imposed by Section 5B-2 a penalty
3assessment equal to the lesser of (i) 5% of the amount of the
4assessment payment not paid on or before the due date plus 5%
5of the portion thereof remaining unpaid on the last day of each
6month thereafter or (ii) 100% of the assessment payment amount
7not paid on or before the due date. For purposes of this
8subsection, payments will be credited first to unpaid
9assessment payment amounts (rather than to penalty or
10interest), beginning with the most delinquent assessment
11payments. Payment cycles of longer than 60 days shall be one
12factor the Director takes into account in granting a waiver
13under this Section.
14    (c-5) If a long-term care facility fails to file its
15assessment bill with payment, there shall, unless waived by
16the Illinois Department for reasonable cause, be added to the
17assessment due a penalty assessment equal to 25% of the
18assessment due. After July 1, 2013, no penalty shall be
19assessed under this Section if the Illinois Department does
20not provide a process for the electronic submission of the
21information required by subsection (a-5).
22    (d) Nothing in this amendatory Act of 1993 shall be
23construed to prevent the Illinois Department from collecting
24all amounts due under this Article pursuant to an assessment
25imposed before the effective date of this amendatory Act of
261993.

 

 

HB4678- 28 -LRB102 24964 KTG 34219 b

1    (e) Nothing in this amendatory Act of the 96th General
2Assembly shall be construed to prevent the Illinois Department
3from collecting all amounts due under this Code pursuant to an
4assessment, tax, fee, or penalty imposed before the effective
5date of this amendatory Act of the 96th General Assembly.
6    (f) No installment of the assessment imposed by Section
75B-2 shall be due and payable until after the Department
8notifies the long-term care providers, in writing, that the
9payment methodologies to long-term care providers required
10under Section 5-5.2 5-5.4 of this Code have been approved by
11the Centers for Medicare and Medicaid Services of the U.S.
12Department of Health and Human Services and the waivers under
1342 CFR 433.68 for the assessment imposed by this Section, if
14necessary, have been granted by the Centers for Medicare and
15Medicaid Services of the U.S. Department of Health and Human
16Services. Upon notification to the Department of approval of
17the payment methodologies required under Section 5-5.2 5-5.4
18of this Code and the waivers granted under 42 CFR 433.68, all
19installments otherwise due under Section 5B-4 prior to the
20date of notification shall be due and payable to the
21Department upon written direction from the Department within
2290 days after issuance by the Comptroller of the payments
23required under Section 5-5.2 5-5.4 of this Code.
24(Source: P.A. 100-501, eff. 6-1-18; 101-649, eff. 7-7-20.)
 
25    (305 ILCS 5/5B-5)  (from Ch. 23, par. 5B-5)

 

 

HB4678- 29 -LRB102 24964 KTG 34219 b

1    Sec. 5B-5. Annual reporting; penalty; maintenance of
2records.
3    (a) After December 31 of each year, and on or before March
431 of the succeeding year, every long-term care provider
5subject to assessment under this Article shall file a report
6with the Illinois Department. The report shall be in a form and
7manner prescribed by the Illinois Department and shall state
8the revenue received by the long-term care provider, reported
9in such categories as may be required by the Illinois
10Department, and other reasonable information the Illinois
11Department requires for the administration of its
12responsibilities under this Code.
13    (b) If a long-term care provider operates or maintains
14more than one long-term care facility in this State, the
15provider may not file a single return covering all those
16long-term care facilities, but shall file a separate return
17for each long-term care facility and shall compute and pay the
18assessment for each long-term care facility separately.
19    (c) Notwithstanding any other provision in this Article,
20in the case of a person who ceases to operate or maintain a
21long-term care facility in respect of which the person is
22subject to assessment under this Article as a long-term care
23provider, the person shall file a final, amended return with
24the Illinois Department not more than 90 days after the
25cessation reflecting the adjustment and shall pay with the
26final return the assessment for the year as so adjusted (to the

 

 

HB4678- 30 -LRB102 24964 KTG 34219 b

1extent not previously paid). If a person fails to file a final
2amended return on a timely basis, there shall, unless waived
3by the Illinois Department for reasonable cause, be added to
4the assessment due a penalty assessment equal to 25% of the
5assessment due.
6    (d) Notwithstanding any other provision of this Article, a
7provider who commences operating or maintaining a long-term
8care facility that was under a prior ownership and remained
9licensed by the Department of Public Health shall notify the
10Illinois Department of any the change in ownership regardless
11of percentage, and shall be responsible to immediately pay any
12prior amounts owed by the facility. In addition, within 90
13days after the effective date of this amendatory Act of the
14102nd General Assembly, all providers operating or maintaining
15a long-term care facility shall notify the Illinois Department
16of all individual owners and any individuals or organizations
17that are part of a limited liability company with ownership of
18that facility and the percentage ownership of each owner. This
19ownership reporting requirement does not include individual
20shareholders in a publicly held corporation.
21    (e) The Department shall develop a procedure for sharing
22with a potential buyer of a facility information regarding
23outstanding assessments and penalties owed by that facility.
24    (f) In the case of a long-term care provider existing as a
25corporation or legal entity other than an individual, the
26return filed by it shall be signed by its president,

 

 

HB4678- 31 -LRB102 24964 KTG 34219 b

1vice-president, secretary, or treasurer or by its properly
2authorized agent.
3    (g) If a long-term care provider fails to file its return
4on or before the due date of the return, 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 25% of the assessment imposed for the
8year. After July 1, 2013, no penalty shall be assessed if the
9Illinois Department has not established a process for the
10electronic submission of information.
11    (h) Every long-term care provider subject to assessment
12under this Article shall keep records and books that will
13permit the determination of occupied bed days on a calendar
14year basis. All such books and records shall be kept in the
15English language and shall, at all times during business hours
16of the day, be subject to inspection by the Illinois
17Department or its duly authorized agents and employees.
18    (i) The Illinois Department shall establish a process for
19long-term care providers to electronically submit all
20information required by this Section no later than July 1,
212013.
22(Source: P.A. 96-1530, eff. 2-16-11; 97-403, eff. 1-1-12;
2397-813, eff. 7-13-12.)
 
24    (305 ILCS 5/5B-8)  (from Ch. 23, par. 5B-8)
25    Sec. 5B-8. Long-Term Care Provider Fund.

 

 

HB4678- 32 -LRB102 24964 KTG 34219 b

1    (a) There is created in the State Treasury the Long-Term
2Care Provider Fund. Interest earned by the Fund shall be
3credited to the Fund. The Fund shall not be used to replace any
4moneys appropriated to the Medicaid program by the General
5Assembly.
6    (b) The Fund is created for the purpose of receiving and
7disbursing moneys in accordance with this Article.
8Disbursements from the Fund shall be made only as follows:
9        (1) For payments to nursing facilities, including
10    county nursing facilities but excluding State-operated
11    facilities, under Title XIX of the Social Security Act and
12    Article V of this Code.
13        (1.5) For payments to managed care organizations as
14    defined in Section 5-30.1 of this Code.
15        (2) For the reimbursement of moneys collected by the
16    Illinois Department through error or mistake.
17        (3) For payment of administrative expenses incurred by
18    the Illinois Department or its agent in performing the
19    activities authorized by this Article.
20        (3.5) For reimbursement of expenses incurred by
21    long-term care facilities, and payment of administrative
22    expenses incurred by the Department of Public Health, in
23    relation to the conduct and analysis of background checks
24    for identified offenders under the Nursing Home Care Act.
25        (4) For payments of any amounts that are reimbursable
26    to the federal government for payments from this Fund that

 

 

HB4678- 33 -LRB102 24964 KTG 34219 b

1    are required to be paid by State warrant.
2        (5) For making transfers to the General Obligation
3    Bond Retirement and Interest Fund, as those transfers are
4    authorized in the proceedings authorizing debt under the
5    Short Term Borrowing Act, but transfers made under this
6    paragraph (5) shall not exceed the principal amount of
7    debt issued in anticipation of the receipt by the State of
8    moneys to be deposited into the Fund.
9        (6) For making transfers, at the direction of the
10    Director of the Governor's Office of Management and Budget
11    during each fiscal year beginning on or after July 1,
12    2011, to other State funds in an annual amount of
13    $20,000,000 of the tax collected pursuant to this Article
14    for the purpose of enforcement of nursing home standards,
15    support of the ombudsman program, and efforts to expand
16    home and community-based services. No transfer under this
17    paragraph shall occur until (i) the payment methodologies
18    created by Public Act 96-1530 under Section 5-5.4 of this
19    Code have been approved by the Centers for Medicare and
20    Medicaid Services of the U.S. Department of Health and
21    Human Services 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    Disbursements from the Fund, other than transfers made
25pursuant to paragraphs (5) and (6) of this subsection, shall
26be by warrants drawn by the State Comptroller upon receipt of

 

 

HB4678- 34 -LRB102 24964 KTG 34219 b

1vouchers duly executed and certified by the Illinois
2Department.
3    (c) The Fund shall consist of the following:
4        (1) All moneys collected or received by the Illinois
5    Department from the long-term care provider assessment
6    imposed by this Article.
7        (2) All federal matching funds received by the
8    Illinois Department as a result of expenditures made from
9    the Fund by the Illinois Department that are attributable
10    to moneys deposited in the Fund.
11        (3) Any interest or penalty levied in conjunction with
12    the administration of this Article.
13        (4) (Blank).
14        (5) All other monies received for the Fund from any
15    other source, including interest earned thereon.
16(Source: P.A. 96-1530, eff. 2-16-11; 97-584, eff. 8-26-11.)
 
17    (305 ILCS 5/5E-10)
18    Sec. 5E-10. Fee. Through December 31, 2021 or upon federal
19approval by the Centers for Medicare and Medicaid Services of
20the long-term care provider assessment described in subsection
21(a-1) of Section 5B-2 of this Code, whichever is later, every
22Every nursing home provider shall pay to the Illinois
23Department, on or before September 10, December 10, March 10,
24and June 10, a fee in the amount of $1.50 for each licensed
25nursing bed day for the calendar quarter in which the payment

 

 

HB4678- 35 -LRB102 24964 KTG 34219 b

1is due. This fee shall not be billed or passed on to any
2resident of a nursing home operated by the nursing home
3provider. All fees received by the Illinois Department under
4this Section shall be deposited into the Long-Term Care
5Provider Fund. This Section 5E-10 is repealed on December 31,
62023.
7(Source: P.A. 88-88; 89-21, eff. 7-1-95.)
 
8    (305 ILCS 5/5E-20 new)
9    Sec. 5E-20. Repealer. This Article 5E is repealed on July
101, 2024.
 
11    Section 99. Effective date. This Act takes effect upon
12becoming law.

 

 

HB4678- 36 -LRB102 24964 KTG 34219 b

1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 100/5-45.21 new
4    225 ILCS 510/3from Ch. 111, par. 953
5    225 ILCS 510/14from Ch. 111, par. 964
6    305 ILCS 5/5-5.2from Ch. 23, par. 5-5.2
7    305 ILCS 5/5B-2from Ch. 23, par. 5B-2
8    305 ILCS 5/5B-4from Ch. 23, par. 5B-4
9    305 ILCS 5/5B-5from Ch. 23, par. 5B-5
10    305 ILCS 5/5B-8from Ch. 23, par. 5B-8
11    305 ILCS 5/5E-10
12    305 ILCS 5/5E-20 new