Full Text of SB2290 97th General Assembly
SB2290 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 SB2290 Introduced 2/10/2011, by Sen. Toi W. Hutchinson SYNOPSIS AS INTRODUCED: |
| 305 ILCS 5/5-5.4 | from Ch. 23, par. 5-5.4 |
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Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that for facilities licensed by the Department of Public Health under the Nursing Home Care Act as Intermediate Care for the Developmentally Disabled facilities or Long Term Care for Under Age 22 facilities, the rates taking effect on July 1, 2011 shall include a 3% increase. Effective July 1, 2011.
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| | | FISCAL NOTE ACT MAY APPLY | |
| | 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,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing 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 | 8 | | and Family Services.
The Department of Healthcare and Family | 9 | | Services shall develop standards of payment of skilled
nursing | 10 | | and intermediate care services in facilities providing such | 11 | | services
under this Article which:
| 12 | | (1) Provide for the determination of a facility's payment
| 13 | | for skilled nursing and intermediate care services on a | 14 | | prospective basis.
The amount of the payment rate for all | 15 | | nursing facilities certified by the
Department of Public Health | 16 | | under the MR/DD Community Care Act or the Nursing Home Care Act | 17 | | as Intermediate
Care for the Developmentally Disabled | 18 | | facilities, Long Term Care for Under Age
22 facilities, Skilled | 19 | | Nursing facilities, or Intermediate Care facilities
under the
| 20 | | medical assistance program shall be prospectively established | 21 | | annually on the
basis of historical, financial, and statistical | 22 | | data reflecting actual costs
from prior years, which shall be | 23 | | applied to the current rate year and updated
for inflation, |
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| 1 | | except that the capital cost element for newly constructed
| 2 | | facilities shall be based upon projected budgets. The annually | 3 | | established
payment rate shall take effect on July 1 in 1984 | 4 | | and subsequent years. No rate
increase and no
update for | 5 | | inflation shall be provided on or after July 1, 1994 and before
| 6 | | July 1, 2011, unless specifically provided for in this
Section.
| 7 | | The changes made by Public Act 93-841
extending the duration of | 8 | | the prohibition against a rate increase or update for inflation | 9 | | are effective retroactive to July 1, 2004.
For facilities | 10 | | licensed by the Department of Public Health under the Nursing | 11 | | Home Care Act as Intermediate Care for the Developmentally | 12 | | Disabled facilities or Long Term Care for Under Age 22 | 13 | | facilities, the rates taking effect on July 1, 2011 shall | 14 | | include a 3% increase. | 15 | | For facilities licensed by the Department of Public Health | 16 | | under the Nursing
Home Care Act as Intermediate Care for the | 17 | | Developmentally Disabled facilities
or Long Term Care for Under | 18 | | Age 22 facilities, the rates taking effect on July
1, 1998 | 19 | | shall include an increase of 3%. For facilities licensed by the
| 20 | | Department of Public Health under the Nursing Home Care Act as | 21 | | Skilled Nursing
facilities or Intermediate Care facilities, | 22 | | the rates taking effect on July 1,
1998 shall include an | 23 | | increase of 3% plus $1.10 per resident-day, as defined by
the | 24 | | Department. For facilities licensed by the Department of Public | 25 | | Health under the Nursing Home Care Act as Intermediate Care | 26 | | Facilities for the Developmentally Disabled or Long Term Care |
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| 1 | | for Under Age 22 facilities, the rates taking effect on January | 2 | | 1, 2006 shall include an increase of 3%.
For facilities | 3 | | licensed by the Department of Public Health under the Nursing | 4 | | Home Care Act as Intermediate Care Facilities for the | 5 | | Developmentally Disabled or Long Term Care for Under Age 22 | 6 | | facilities, the rates taking effect on January 1, 2009 shall | 7 | | include an increase sufficient to provide a $0.50 per hour wage | 8 | | increase for non-executive staff. | 9 | | For facilities licensed by the Department of Public Health | 10 | | under the
Nursing Home Care Act as Intermediate Care for the | 11 | | Developmentally Disabled
facilities or Long Term Care for Under | 12 | | Age 22 facilities, the rates taking
effect on July 1, 1999 | 13 | | shall include an increase of 1.6% plus $3.00 per
resident-day, | 14 | | as defined by the Department. For facilities licensed by the
| 15 | | Department of Public Health under the Nursing Home Care Act as | 16 | | Skilled Nursing
facilities or Intermediate Care facilities, | 17 | | the rates taking effect on July 1,
1999 shall include an | 18 | | increase of 1.6% and, for services provided on or after
October | 19 | | 1, 1999, shall be increased by $4.00 per resident-day, as | 20 | | defined by
the Department.
| 21 | | For facilities licensed by the Department of Public Health | 22 | | under the
Nursing Home Care Act as Intermediate Care for the | 23 | | Developmentally Disabled
facilities or Long Term Care for Under | 24 | | Age 22 facilities, the rates taking
effect on July 1, 2000 | 25 | | shall include an increase of 2.5% per resident-day,
as defined | 26 | | by the Department. For facilities licensed by the Department of
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| 1 | | Public Health under the Nursing Home Care Act as Skilled | 2 | | Nursing facilities or
Intermediate Care facilities, the rates | 3 | | taking effect on July 1, 2000 shall
include an increase of 2.5% | 4 | | per resident-day, as defined by the Department.
| 5 | | For facilities licensed by the Department of Public Health | 6 | | under the
Nursing Home Care Act as skilled nursing facilities | 7 | | or intermediate care
facilities, a new payment methodology must | 8 | | be implemented for the nursing
component of the rate effective | 9 | | July 1, 2003. The Department of Public Aid
(now Healthcare and | 10 | | Family Services) shall develop the new payment methodology | 11 | | using the Minimum Data Set
(MDS) as the instrument to collect | 12 | | information concerning nursing home
resident condition | 13 | | necessary to compute the rate. The Department
shall develop the | 14 | | new payment methodology to meet the unique needs of
Illinois | 15 | | nursing home residents while remaining subject to the | 16 | | appropriations
provided by the General Assembly.
A transition | 17 | | period from the payment methodology in effect on June 30, 2003
| 18 | | to the payment methodology in effect on July 1, 2003 shall be | 19 | | provided for a
period not exceeding 3 years and 184 days after | 20 | | implementation of the new payment
methodology as follows:
| 21 | | (A) For a facility that would receive a lower
nursing | 22 | | component rate per patient day under the new system than | 23 | | the facility
received
effective on the date immediately | 24 | | preceding the date that the Department
implements the new | 25 | | payment methodology, the nursing component rate per | 26 | | patient
day for the facility
shall be held at
the level in |
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| 1 | | effect on the date immediately preceding the date that the
| 2 | | Department implements the new payment methodology until a | 3 | | higher nursing
component rate of
reimbursement is achieved | 4 | | by that
facility.
| 5 | | (B) For a facility that would receive a higher nursing | 6 | | component rate per
patient day under the payment | 7 | | methodology in effect on July 1, 2003 than the
facility | 8 | | received effective on the date immediately preceding the | 9 | | date that the
Department implements the new payment | 10 | | methodology, the nursing component rate
per patient day for | 11 | | the facility shall be adjusted.
| 12 | | (C) Notwithstanding paragraphs (A) and (B), the | 13 | | nursing component rate per
patient day for the facility | 14 | | shall be adjusted subject to appropriations
provided by the | 15 | | General Assembly.
| 16 | | For facilities licensed by the Department of Public Health | 17 | | under the
Nursing Home Care Act as Intermediate Care for the | 18 | | Developmentally Disabled
facilities or Long Term Care for Under | 19 | | Age 22 facilities, the rates taking
effect on March 1, 2001 | 20 | | shall include a statewide increase of 7.85%, as
defined by the | 21 | | Department.
| 22 | | Notwithstanding any other provision of this Section, for | 23 | | facilities licensed by the Department of Public Health under | 24 | | the
Nursing Home Care Act as skilled nursing facilities or | 25 | | intermediate care
facilities, the numerator of the ratio used | 26 | | by the Department of Healthcare and Family Services to compute |
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| 1 | | the rate payable under this Section using the Minimum Data Set | 2 | | (MDS) methodology shall incorporate the following annual | 3 | | amounts as the additional funds appropriated to the Department | 4 | | specifically to pay for rates based on the MDS nursing | 5 | | component methodology in excess of the funding in effect on | 6 | | December 31, 2006: | 7 | | (i) For rates taking effect January 1, 2007, | 8 | | $60,000,000. | 9 | | (ii) For rates taking effect January 1, 2008, | 10 | | $110,000,000. | 11 | | (iii) For rates taking effect January 1, 2009, | 12 | | $194,000,000. | 13 | | Notwithstanding any other provision of this Section, for | 14 | | facilities licensed by the Department of Public Health under | 15 | | the Nursing Home Care Act as skilled nursing facilities or | 16 | | intermediate care facilities, the support component of the | 17 | | rates taking effect on January 1, 2008 shall be computed using | 18 | | the most recent cost reports on file with the Department of | 19 | | Healthcare and Family Services no later than April 1, 2005, | 20 | | updated for inflation to January 1, 2006. | 21 | | For facilities licensed by the Department of Public Health | 22 | | under the
Nursing Home Care Act as Intermediate Care for the | 23 | | Developmentally Disabled
facilities or Long Term Care for Under | 24 | | Age 22 facilities, the rates taking
effect on April 1, 2002 | 25 | | shall include a statewide increase of 2.0%, as
defined by the | 26 | | Department.
This increase terminates on July 1, 2002;
beginning |
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| 1 | | July 1, 2002 these rates are reduced to the level of the rates
| 2 | | in effect on March 31, 2002, as defined by the Department.
| 3 | | For facilities licensed by the Department of Public Health | 4 | | under the
Nursing Home Care Act as skilled nursing facilities | 5 | | or intermediate care
facilities, the rates taking effect on | 6 | | July 1, 2001 shall be computed using the most recent cost | 7 | | reports
on file with the Department of Public Aid no later than | 8 | | April 1, 2000,
updated for inflation to January 1, 2001. For | 9 | | rates effective July 1, 2001
only, rates shall be the greater | 10 | | of the rate computed for July 1, 2001
or the rate effective on | 11 | | June 30, 2001.
| 12 | | Notwithstanding any other provision of this Section, for | 13 | | facilities
licensed by the Department of Public Health under | 14 | | the Nursing Home Care Act
as skilled nursing facilities or | 15 | | intermediate care facilities, the Illinois
Department shall | 16 | | determine by rule the rates taking effect on July 1, 2002,
| 17 | | which shall be 5.9% less than the rates in effect on June 30, | 18 | | 2002.
| 19 | | Notwithstanding any other provision of this Section, for | 20 | | facilities
licensed by the Department of Public Health under | 21 | | the Nursing Home Care Act as
skilled nursing
facilities or | 22 | | intermediate care facilities, if the payment methodologies | 23 | | required under Section 5A-12 and the waiver granted under 42 | 24 | | CFR 433.68 are approved by the United States Centers for | 25 | | Medicare and Medicaid Services, the rates taking effect on July | 26 | | 1, 2004 shall be 3.0% greater than the rates in effect on June |
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| 1 | | 30, 2004. These rates shall take
effect only upon approval and
| 2 | | implementation of the payment methodologies required under | 3 | | Section 5A-12.
| 4 | | Notwithstanding any other provisions of this Section, for | 5 | | facilities licensed by the Department of Public Health under | 6 | | the Nursing Home Care Act as skilled nursing facilities or | 7 | | intermediate care facilities, the rates taking effect on | 8 | | January 1, 2005 shall be 3% more than the rates in effect on | 9 | | December 31, 2004.
| 10 | | Notwithstanding any other provision of this Section, for | 11 | | facilities licensed by the Department of Public Health under | 12 | | the Nursing Home Care Act as skilled nursing facilities or | 13 | | intermediate care facilities, effective January 1, 2009, the | 14 | | per diem support component of the rates effective on January 1, | 15 | | 2008, computed using the most recent cost reports on file with | 16 | | the Department of Healthcare and Family Services no later than | 17 | | April 1, 2005, updated for inflation to January 1, 2006, shall | 18 | | be increased to the amount that would have been derived using | 19 | | standard Department of Healthcare and Family Services methods, | 20 | | procedures, and inflators. | 21 | | Notwithstanding any other provisions of this Section, for | 22 | | facilities licensed by the Department of Public Health under | 23 | | the Nursing Home Care Act as intermediate care facilities that | 24 | | are federally defined as Institutions for Mental Disease, a | 25 | | socio-development component rate equal to 6.6% of the | 26 | | facility's nursing component rate as of January 1, 2006 shall |
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| 1 | | be established and paid effective July 1, 2006. The | 2 | | socio-development component of the rate shall be increased by a | 3 | | factor of 2.53 on the first day of the month that begins at | 4 | | least 45 days after January 11, 2008 (the effective date of | 5 | | Public Act 95-707). As of August 1, 2008, the socio-development | 6 | | component rate shall be equal to 6.6% of the facility's nursing | 7 | | component rate as of January 1, 2006, multiplied by a factor of | 8 | | 3.53. The Illinois Department may by rule adjust these | 9 | | socio-development component rates, but in no case may such | 10 | | rates be diminished.
| 11 | | For facilities
licensed
by the
Department of Public Health | 12 | | under the Nursing Home Care Act as Intermediate
Care for
the | 13 | | Developmentally Disabled facilities or as long-term care | 14 | | facilities for
residents under 22 years of age, the rates | 15 | | taking effect on July 1,
2003 shall
include a statewide | 16 | | increase of 4%, as defined by the Department.
| 17 | | For facilities licensed by the Department of Public Health | 18 | | under the
Nursing Home Care Act as Intermediate Care for the | 19 | | Developmentally Disabled
facilities or Long Term Care for Under | 20 | | Age 22 facilities, the rates taking
effect on the first day of | 21 | | the month that begins at least 45 days after the effective date | 22 | | of this amendatory Act of the 95th General Assembly shall | 23 | | include a statewide increase of 2.5%, as
defined by the | 24 | | Department. | 25 | | Notwithstanding any other provision of this Section, for | 26 | | facilities licensed by the Department of Public Health under |
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| 1 | | the Nursing Home Care Act as skilled nursing facilities or | 2 | | intermediate care facilities, effective January 1, 2005, | 3 | | facility rates shall be increased by the difference between (i) | 4 | | a facility's per diem property, liability, and malpractice | 5 | | insurance costs as reported in the cost report filed with the | 6 | | Department of Public Aid and used to establish rates effective | 7 | | July 1, 2001 and (ii) those same costs as reported in the | 8 | | facility's 2002 cost report. These costs shall be passed | 9 | | through to the facility without caps or limitations, except for | 10 | | adjustments required under normal auditing procedures.
| 11 | | Rates established effective each July 1 shall govern | 12 | | payment
for services rendered throughout that fiscal year, | 13 | | except that rates
established on July 1, 1996 shall be | 14 | | increased by 6.8% for services
provided on or after January 1, | 15 | | 1997. Such rates will be based
upon the rates calculated for | 16 | | the year beginning July 1, 1990, and for
subsequent years | 17 | | thereafter until June 30, 2001 shall be based on the
facility | 18 | | cost reports
for the facility fiscal year ending at any point | 19 | | in time during the previous
calendar year, updated to the | 20 | | midpoint of the rate year. The cost report
shall be on file | 21 | | with the Department no later than April 1 of the current
rate | 22 | | year. Should the cost report not be on file by April 1, the | 23 | | Department
shall base the rate on the latest cost report filed | 24 | | by each skilled care
facility and intermediate care facility, | 25 | | updated to the midpoint of the
current rate year. In | 26 | | determining rates for services rendered on and after
July 1, |
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| 1 | | 1985, fixed time shall not be computed at less than zero. The
| 2 | | Department shall not make any alterations of regulations which | 3 | | would reduce
any component of the Medicaid rate to a level | 4 | | below what that component would
have been utilizing in the rate | 5 | | effective on July 1, 1984.
| 6 | | (2) Shall take into account the actual costs incurred by | 7 | | facilities
in providing services for recipients of skilled | 8 | | nursing and intermediate
care services under the medical | 9 | | assistance program.
| 10 | | (3) Shall take into account the medical and psycho-social
| 11 | | characteristics and needs of the patients.
| 12 | | (4) Shall take into account the actual costs incurred by | 13 | | facilities in
meeting licensing and certification standards | 14 | | imposed and prescribed by the
State of Illinois, any of its | 15 | | political subdivisions or municipalities and by
the U.S. | 16 | | Department of Health and Human Services pursuant to Title XIX | 17 | | of the
Social Security Act.
| 18 | | The Department of Healthcare and Family Services
shall | 19 | | develop precise standards for
payments to reimburse nursing | 20 | | facilities for any utilization of
appropriate rehabilitative | 21 | | personnel for the provision of rehabilitative
services which is | 22 | | authorized by federal regulations, including
reimbursement for | 23 | | services provided by qualified therapists or qualified
| 24 | | assistants, and which is in accordance with accepted | 25 | | professional
practices. Reimbursement also may be made for | 26 | | utilization of other
supportive personnel under appropriate |
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| 1 | | supervision.
| 2 | | (Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707, | 3 | | eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09; | 4 | | 96-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff. | 5 | | 7-2-10.)
| 6 | | Section 99. Effective date. This Act takes effect July 1, | 7 | | 2011.
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