Full Text of SB0741 98th General Assembly
SB0741sam001 98TH GENERAL ASSEMBLY | Sen. Donne E. Trotter Filed: 3/25/2014
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| 1 | | AMENDMENT TO SENATE BILL 741
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 741 by replacing | 3 | | everything after the enacting clause with the following:
| 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 |
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| 1 | | bills payable for nursing services rendered on or after a new | 2 | | reimbursement system based on the Resource Utilization Groups | 3 | | (RUGs) has been fully operationalized, which shall take effect | 4 | | for services provided on or after January 1, 2014. | 5 | | (d) The new nursing services reimbursement methodology | 6 | | utilizing RUG-IV 48 grouper model, which shall be referred to | 7 | | as the RUGs reimbursement system, taking effect January 1, | 8 | | 2014, shall be based on the following: | 9 | | (1) The methodology shall be resident-driven, | 10 | | facility-specific, and cost-based. | 11 | | (2) Costs shall be annually rebased and case mix index | 12 | | quarterly updated. The nursing services methodology will | 13 | | be assigned to the Medicaid enrolled residents on record as | 14 | | of 30 days prior to the beginning of the rate period in the | 15 | | Department's Medicaid Management Information System (MMIS) | 16 | | as present on the last day of the second quarter preceding | 17 | | the rate period. | 18 | | (3) Regional wage adjustors based on the Health Service | 19 | | Areas (HSA) groupings and adjusters in effect on April 30, | 20 | | 2012 shall be included. | 21 | | (4) Case mix index shall be assigned to each resident | 22 | | class based on the Centers for Medicare and Medicaid | 23 | | Services staff time measurement study in effect on July 1, | 24 | | 2013, utilizing an index maximization approach. | 25 | | (5) The pool of funds available for distribution by | 26 | | case mix and the base facility rate shall be determined |
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| 1 | | using the formula contained in subsection (d-1). | 2 | | (d-1) Calculation of base year Statewide RUG-IV nursing | 3 | | base per diem rate. | 4 | | (1) Base rate spending pool shall be: | 5 | | (A) The base year resident days which are | 6 | | calculated by multiplying the number of Medicaid | 7 | | residents in each nursing home as indicated in the MDS | 8 | | data defined in paragraph (4) by 365. | 9 | | (B) Each facility's nursing component per diem in | 10 | | effect on July 1, 2012 shall be multiplied by | 11 | | subsection (A). | 12 | | (C) Thirteen million is added to the product of | 13 | | subparagraph (A) and subparagraph (B) to adjust for the | 14 | | exclusion of nursing homes defined in paragraph (5). | 15 | | (2) For each nursing home with Medicaid residents as | 16 | | indicated by the MDS data defined in paragraph (4), | 17 | | weighted days adjusted for case mix and regional wage | 18 | | adjustment shall be calculated. For each home this | 19 | | calculation is the product of: | 20 | | (A) Base year resident days as calculated in | 21 | | subparagraph (A) of paragraph (1). | 22 | | (B) The nursing home's regional wage adjustor | 23 | | based on the Health Service Areas (HSA) groupings and | 24 | | adjustors in effect on April 30, 2012. | 25 | | (C) Facility weighted case mix which is the number | 26 | | of Medicaid residents as indicated by the MDS data |
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| 1 | | defined in paragraph (4) multiplied by the associated | 2 | | case weight for the RUG-IV 48 grouper model using | 3 | | standard RUG-IV procedures for index maximization. | 4 | | (D) The sum of the products calculated for each | 5 | | nursing home in subparagraphs (A) through (C) above | 6 | | shall be the base year case mix, rate adjusted weighted | 7 | | days. | 8 | | (3) The Statewide RUG-IV nursing base per diem rate on | 9 | | January 1, 2014 shall be the quotient of the paragraph (1) | 10 | | divided by the sum calculated under subparagraph (D) of | 11 | | paragraph (2). | 12 | | (4) Minimum Data Set (MDS) comprehensive assessments | 13 | | for Medicaid residents on the last day of the quarter used | 14 | | to establish the base rate. | 15 | | (5) Nursing facilities designated as of July 1, 2012 by | 16 | | the Department as "Institutions for Mental Disease" shall | 17 | | be excluded from all calculations under this subsection. | 18 | | The data from these facilities shall not be used in the | 19 | | computations described in paragraphs (1) through (4) above | 20 | | to establish the base rate. | 21 | | (e) Notwithstanding any other provision of this Code, the | 22 | | Department shall by rule develop a reimbursement methodology | 23 | | reflective of the intensity of care and services requirements | 24 | | of low need residents in the lowest RUG IV groupers and | 25 | | corresponding regulations. Only that portion of the RUGs | 26 | | Reimbursement System spending pool described in subsection |
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| 1 | | (d-1) attributed to the groupers as of July 1, 2013 for which | 2 | | the methodology in this Section is developed may be diverted | 3 | | for this purpose. The Department shall submit the rules no | 4 | | later than January 1, 2014 for an implementation date no later | 5 | | than January 1, 2015. If the Department does not implement this | 6 | | reimbursement methodology by the required date, the nursing | 7 | | component per diem on January 1, 2015 for residents classified | 8 | | in RUG-IV groups PA1, PA2, BA1, and BA2 shall be the blended | 9 | | rate of the calculated RUG-IV nursing component per diem and | 10 | | the nursing component per diem in effect on July 1, 2012. This | 11 | | blended rate shall be applied only to nursing homes whose | 12 | | resident population is greater than or equal to 70% of the | 13 | | total residents served and whose RUG-IV nursing component per | 14 | | diem rate is less than the nursing component per diem in effect | 15 | | on July 1, 2012. This blended rate shall be in effect until the | 16 | | reimbursement methodology is implemented or until July 1, 2019, | 17 | | whichever is sooner. | 18 | | (e-1) Notwithstanding any other provision of this Article, | 19 | | rates established pursuant to this subsection shall not apply | 20 | | to any and all nursing facilities designated by the Department | 21 | | as "Institutions for Mental Disease" and shall be excluded from | 22 | | the RUGs Reimbursement System applicable to facilities not | 23 | | designated as "Institutions for the Mentally Diseased" by the | 24 | | Department. | 25 | | (e-2) For dates of services beginning January 1, 2014, the | 26 | | RUG-IV nursing component per diem for a nursing home shall be |
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| 1 | | the product of the statewide RUG-IV nursing base per diem rate, | 2 | | the facility average case mix index, and the regional wage | 3 | | adjustor. Transition rates for services provided between | 4 | | January 1, 2014 and December 31, 2014 shall be as follows: | 5 | | (1) The transition RUG-IV per diem nursing rate for | 6 | | nursing homes whose rate calculated in this subsection | 7 | | (e-2) is greater than the nursing component rate in effect | 8 | | July 1, 2012 shall be paid the sum of: | 9 | | (A) The nursing component rate in effect July 1, | 10 | | 2012; plus | 11 | | (B) The difference of the RUG-IV nursing component | 12 | | per diem calculated for the current quarter minus the | 13 | | nursing component rate in effect July 1, 2012 | 14 | | multiplied by 0.88. | 15 | | (2) The transition RUG-IV per diem nursing rate for | 16 | | nursing homes whose rate calculated in this subsection | 17 | | (e-2) is less than the nursing component rate in effect | 18 | | July 1, 2012 shall be paid the sum of: | 19 | | (A) The nursing component rate in effect July 1, | 20 | | 2012; plus | 21 | | (B) The difference of the RUG-IV nursing component | 22 | | per diem calculated for the current quarter minus the | 23 | | nursing component rate in effect July 1, 2012 | 24 | | multiplied by 0.13. | 25 | | (e-3) Notwithstanding any other provisions of this Code, on | 26 | | and after January 1, 2014, the per diem reimbursement rate for |
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| 1 | | each individual resident receiving ventilator services, | 2 | | including those receiving weaning services, shall include the | 3 | | nursing, support, and capital components in effect at the time | 4 | | the service is provided plus a service fee of $34 per resident | 5 | | per day and a supply fee of $174 per resident per day. | 6 | | (f) Notwithstanding any other provision of this Code, on | 7 | | and after July 1, 2012, reimbursement rates associated with the | 8 | | nursing or support components of the current nursing facility | 9 | | rate methodology shall not increase beyond the level effective | 10 | | May 1, 2011 until a new reimbursement system based on the RUGs | 11 | | IV 48 grouper model has been fully operationalized. | 12 | | (g) Notwithstanding any other provision of this Code, on | 13 | | and after July 1, 2012, for facilities not designated by the | 14 | | Department of Healthcare and Family Services as "Institutions | 15 | | for Mental Disease", rates effective May 1, 2011 shall be | 16 | | adjusted as follows: | 17 | | (1) Individual nursing rates for residents classified | 18 | | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | 19 | | ending March 31, 2012 shall be reduced by 10%; | 20 | | (2) Individual nursing rates for residents classified | 21 | | in all other RUG IV groups shall be reduced by 1.0%; | 22 | | (3) Facility rates for the capital and support | 23 | | components shall be reduced by 1.7%. | 24 | | (h) Notwithstanding any other provision of this Code, on | 25 | | and after July 1, 2012, nursing facilities designated by the | 26 | | Department of Healthcare and Family Services as "Institutions |
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| 1 | | for Mental Disease" and "Institutions for Mental Disease" that | 2 | | are facilities licensed under the Specialized Mental Health | 3 | | Rehabilitation Act of 2013 shall have the nursing, | 4 | | socio-developmental, capital, and support components of their | 5 | | reimbursement rate effective May 1, 2011 reduced in total by | 6 | | 2.7%. | 7 | | (Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section | 8 | | 6-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff. | 9 | | 7-22-13; revised 9-19-13.)
| 10 | | Section 99. Effective date. This Act takes effect upon | 11 | | becoming law.".
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