Full Text of SB0741 98th General Assembly
SB0741eng 98TH GENERAL ASSEMBLY |
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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 5-5.2 as follows:
| 6 | | (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
| 7 | | Sec. 5-5.2. Payment.
| 8 | | (a) All nursing facilities that are grouped pursuant to | 9 | | Section
5-5.1 of this Act shall receive the same rate of | 10 | | payment for similar
services.
| 11 | | (b) It shall be a matter of State policy that the Illinois | 12 | | Department
shall utilize a uniform billing cycle throughout the | 13 | | State for the
long-term care providers.
| 14 | | (c) Notwithstanding any other provisions of this Code, the | 15 | | methodologies for reimbursement of nursing services as | 16 | | provided under this Article shall no longer be applicable for | 17 | | bills payable for nursing services rendered on or after a new | 18 | | reimbursement system based on the Resource Utilization Groups | 19 | | (RUGs) has been fully operationalized, which shall take effect | 20 | | for services provided on or after January 1, 2014. | 21 | | (d) The new nursing services reimbursement methodology | 22 | | utilizing RUG-IV 48 grouper model, which shall be referred to | 23 | | as the RUGs reimbursement system, taking effect January 1, |
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| 1 | | 2014, shall be based on the following: | 2 | | (1) The methodology shall be resident-driven, | 3 | | facility-specific, and cost-based. | 4 | | (2) Costs shall be annually rebased and case mix index | 5 | | quarterly updated. The nursing services methodology will | 6 | | be assigned to the Medicaid enrolled residents on record as | 7 | | of 30 days prior to the beginning of the rate period in the | 8 | | Department's Medicaid Management Information System (MMIS) | 9 | | as present on the last day of the second quarter preceding | 10 | | the rate period. | 11 | | (3) Regional wage adjustors based on the Health Service | 12 | | Areas (HSA) groupings and adjusters in effect on April 30, | 13 | | 2012 shall be included. | 14 | | (4) Case mix index shall be assigned to each resident | 15 | | class based on the Centers for Medicare and Medicaid | 16 | | Services staff time measurement study in effect on July 1, | 17 | | 2013, utilizing an index maximization approach. | 18 | | (5) The pool of funds available for distribution by | 19 | | case mix and the base facility rate shall be determined | 20 | | using the formula contained in subsection (d-1). | 21 | | (d-1) Calculation of base year Statewide RUG-IV nursing | 22 | | base per diem rate. | 23 | | (1) Base rate spending pool shall be: | 24 | | (A) The base year resident days which are | 25 | | calculated by multiplying the number of Medicaid | 26 | | residents in each nursing home as indicated in the MDS |
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| 1 | | data defined in paragraph (4) by 365. | 2 | | (B) Each facility's nursing component per diem in | 3 | | effect on July 1, 2012 shall be multiplied by | 4 | | subsection (A). | 5 | | (C) Thirteen million is added to the product of | 6 | | subparagraph (A) and subparagraph (B) to adjust for the | 7 | | exclusion of nursing homes defined in paragraph (5). | 8 | | (2) For each nursing home with Medicaid residents as | 9 | | indicated by the MDS data defined in paragraph (4), | 10 | | weighted days adjusted for case mix and regional wage | 11 | | adjustment shall be calculated. For each home this | 12 | | calculation is the product of: | 13 | | (A) Base year resident days as calculated in | 14 | | subparagraph (A) of paragraph (1). | 15 | | (B) The nursing home's regional wage adjustor | 16 | | based on the Health Service Areas (HSA) groupings and | 17 | | adjustors in effect on April 30, 2012. | 18 | | (C) Facility weighted case mix which is the number | 19 | | of Medicaid residents as indicated by the MDS data | 20 | | defined in paragraph (4) multiplied by the associated | 21 | | case weight for the RUG-IV 48 grouper model using | 22 | | standard RUG-IV procedures for index maximization. | 23 | | (D) The sum of the products calculated for each | 24 | | nursing home in subparagraphs (A) through (C) above | 25 | | shall be the base year case mix, rate adjusted weighted | 26 | | days. |
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| 1 | | (3) The Statewide RUG-IV nursing base per diem rate on | 2 | | January 1, 2014 shall be the quotient of the paragraph (1) | 3 | | divided by the sum calculated under subparagraph (D) of | 4 | | paragraph (2). | 5 | | (3-1) Beginning January 1, 2015 and every quarter | 6 | | thereafter, the base per diem rate set by the calculations | 7 | | contained in this Section, which is $83.49, shall be | 8 | | adjusted by the addition of the quotient of $32,000,000 set | 9 | | aside for this purpose and any additional moneys as | 10 | | provided in paragraph (4) of subsection (e) and subsection | 11 | | (e-3) divided by the sum calculated under subparagraph (D) | 12 | | of paragraph (2). | 13 | | (4) Minimum Data Set (MDS) comprehensive assessments | 14 | | for Medicaid residents on March 31, 2012 the last day of | 15 | | the quarter used to establish the base rate . | 16 | | (5) Nursing facilities designated as of July 1, 2012 by | 17 | | the Department as "Institutions for Mental Disease" shall | 18 | | be excluded from all calculations under this subsection. | 19 | | The data from these facilities shall not be used in the | 20 | | computations described in paragraphs (1) through (4) above | 21 | | to establish the base rate. | 22 | | (e) Notwithstanding any other provision of this Code, the | 23 | | Department shall by rule develop a reimbursement methodology | 24 | | reflective of the intensity of care and services requirements | 25 | | of low need residents in the lowest RUG IV groupers and | 26 | | corresponding regulations. Only that portion of the RUGs |
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| 1 | | Reimbursement System spending pool described in subsection | 2 | | (d-1) attributed to the groupers as of July 1, 2013 for which | 3 | | the methodology in this Section is developed may be diverted | 4 | | for this purpose. The Department shall submit the rules no | 5 | | later than January 1, 2014 for an implementation date no later | 6 | | than January 1, 2015 which shall establish at a minimum the | 7 | | following add-on adjustments to the facility's RUG-IV rate: . | 8 | | (1) at a minimum a $208 per day add-on for each | 9 | | resident qualifying for ventilator care adjustment as | 10 | | outlined in the administrative rules of the Department of | 11 | | Healthcare and Family Services; | 12 | | (2) at a minimum a $5 per day add-on for each resident | 13 | | residing in a dedicated Alzheimer's unit with an | 14 | | Alzheimer's or a non-Alzheimer's dementia diagnosis as | 15 | | scored on the MDS 3.0; | 16 | | (3) at a minimum a $2.50 per day add-on for each | 17 | | resident falling in the bottom 4 RUG-IV groupers with an | 18 | | Alzheimer's or a non-Alzheimer's dementia diagnosis not | 19 | | residing in a dedicated Alzheimer's unit as scored on the | 20 | | MDS 3.0; and | 21 | | (4) at a minimum a $3.00 per day add-on for each | 22 | | resident with a diagnosis of a serious mental illness. If | 23 | | for any quarter the amount needed for the serious mental | 24 | | illness add-on is less than $2,000,000, the difference | 25 | | shall be added to the base rate adjustment as provided in | 26 | | paragraph (3-1) of subsection (d-1). |
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| 1 | | For the purpose of the add-on calculations, a dedicated | 2 | | Alzheimer's unit must meet the criteria set forth in Subpart U | 3 | | of Title 77, Part 300 of the Illinois Administrative Code. | 4 | | "Serious mental illness" means a primary or secondary SMI | 5 | | diagnosis in one of MDS 3.0 items S1200 A through I. | 6 | | "Alzheimer's" and "non-Alzheimer's dementia" means a diagnosis | 7 | | in MDS 3.0 item I4200 or I4800. | 8 | | If the Department does not implement this reimbursement | 9 | | methodology by the required date, the nursing component per | 10 | | diem on January 1, 2015 for residents classified in RUG-IV | 11 | | groups PA1, PA2, BA1, and BA2 shall be the blended rate of the | 12 | | calculated RUG-IV nursing component per diem and the nursing | 13 | | component per diem in effect on July 1, 2012. This blended rate | 14 | | shall be applied only to nursing homes whose resident | 15 | | population is greater than or equal to 70% of the total | 16 | | residents served and whose RUG-IV nursing component per diem | 17 | | rate is less than the nursing component per diem in effect on | 18 | | July 1, 2012. This blended rate shall be in effect until the | 19 | | reimbursement methodology is implemented or until July 1, 2019, | 20 | | whichever is sooner. | 21 | | (e-1) Notwithstanding any other provision of this Article, | 22 | | rates established pursuant to this subsection shall not apply | 23 | | to any and all nursing facilities designated by the Department | 24 | | as "Institutions for Mental Disease" and shall be excluded from | 25 | | the RUGs Reimbursement System applicable to facilities not | 26 | | designated as "Institutions for the Mentally Diseased" by the |
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| 1 | | Department. | 2 | | (e-2) For dates of services beginning January 1, 2014, the | 3 | | RUG-IV nursing component per diem for a nursing home shall be | 4 | | the product of the statewide RUG-IV nursing base per diem rate, | 5 | | the facility average case mix index, and the regional wage | 6 | | adjustor. Transition rates for services provided between | 7 | | January 1, 2014 and December 31, 2014 shall be as follows: | 8 | | (1) The transition RUG-IV per diem nursing rate for | 9 | | nursing homes whose rate calculated in this subsection | 10 | | (e-2) is greater than the nursing component rate in effect | 11 | | July 1, 2012 shall be paid the sum of: | 12 | | (A) The nursing component rate in effect July 1, | 13 | | 2012; plus | 14 | | (B) The difference of the RUG-IV nursing component | 15 | | per diem calculated for the current quarter minus the | 16 | | nursing component rate in effect July 1, 2012 | 17 | | multiplied by 0.88. | 18 | | (2) The transition RUG-IV per diem nursing rate for | 19 | | nursing homes whose rate calculated in this subsection | 20 | | (e-2) is less than the nursing component rate in effect | 21 | | July 1, 2012 shall be paid the sum of: | 22 | | (A) The nursing component rate in effect July 1, | 23 | | 2012; plus | 24 | | (B) The difference of the RUG-IV nursing component | 25 | | per diem calculated for the current quarter minus the | 26 | | nursing component rate in effect July 1, 2012 |
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| 1 | | multiplied by 0.13. | 2 | | (e-3) Notwithstanding any other provision of this Code, an | 3 | | amount equal to $16,000,000 shall be set aside for the | 4 | | establishment of a quality incentive initiative effective | 5 | | January 1, 2015. In any quarter in which quality incentive | 6 | | awards do not equal $4,000,000, the difference shall be added | 7 | | to the base rate adjustment as provided in paragraph (3-1) of | 8 | | subsection (d-1). | 9 | | (f) Notwithstanding any other provision of this Code, on | 10 | | and after July 1, 2012, reimbursement rates associated with the | 11 | | nursing or support components of the current nursing facility | 12 | | rate methodology shall not increase beyond the level effective | 13 | | May 1, 2011 until a new reimbursement system based on the RUGs | 14 | | IV 48 grouper model has been fully operationalized. | 15 | | (g) Notwithstanding any other provision of this Code, on | 16 | | and after July 1, 2012, for facilities not designated by the | 17 | | Department of Healthcare and Family Services as "Institutions | 18 | | for Mental Disease", rates effective May 1, 2011 shall be | 19 | | adjusted as follows: | 20 | | (1) Individual nursing rates for residents classified | 21 | | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | 22 | | ending March 31, 2012 shall be reduced by 10%; | 23 | | (2) Individual nursing rates for residents classified | 24 | | in all other RUG IV groups shall be reduced by 1.0%; | 25 | | (3) Facility rates for the capital and support | 26 | | components shall be reduced by 1.7%. |
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| 1 | | (h) Notwithstanding any other provision of this Code, on | 2 | | and after July 1, 2012, nursing facilities designated by the | 3 | | Department of Healthcare and Family Services as "Institutions | 4 | | for Mental Disease" and "Institutions for Mental Disease" that | 5 | | are facilities licensed under the Specialized Mental Health | 6 | | Rehabilitation Act of 2013 shall have the nursing, | 7 | | socio-developmental, capital, and support components of their | 8 | | reimbursement rate effective May 1, 2011 reduced in total by | 9 | | 2.7%. | 10 | | (Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section | 11 | | 6-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff. | 12 | | 7-22-13; revised 9-19-13.)
| 13 | | Section 99. Effective date. This Act takes effect upon | 14 | | becoming law. |
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