Full Text of SB0419 99th General Assembly
SB0419sam001 99TH GENERAL ASSEMBLY | Sen. Heather A. Steans Filed: 4/7/2016
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| 1 | | AMENDMENT TO SENATE BILL 419
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 419 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 1. Findings. The General Assembly finds as | 5 | | follows: | 6 | | (1) It is in the best interest of the citizens of | 7 | | Illinois to review and update Medicaid payment | 8 | | methodologies to ensure the best use of public resources. | 9 | | (2) The intent of the $6.07 tax per occupied bed day | 10 | | imposed by Public Act 96-1530 was to pay for increased | 11 | | staffing under Public Act 96-1372. | 12 | | (3) Many nursing homes are still staffed below the | 13 | | legal level required under Section 3-202.05 of the Nursing | 14 | | Home Care Act. | 15 | | (4) Some low-staffed homes have gained from the higher | 16 | | Medicaid rates but have not increased staffing. | 17 | | (5) Policy research has noted the significant positive |
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| 1 | | relationship between nursing home staffing levels and | 2 | | quality of care. | 3 | | (6) The State of Illinois desires to pay for value and | 4 | | quality not just volume. | 5 | | (7) The use of regional wage adjusters rewards or | 6 | | penalizes nursing homes solely on location and does not | 7 | | account for staffing levels or actual wages paid. | 8 | | Section 5. The Illinois Public Aid Code is amended by | 9 | | changing Section 5-5.2 as follows:
| 10 | | (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
| 11 | | Sec. 5-5.2. Payment.
| 12 | | (a) All nursing facilities that are grouped pursuant to | 13 | | Section
5-5.1 of this Act shall receive the same rate of | 14 | | payment for similar
services.
| 15 | | (b) It shall be a matter of State policy that the Illinois | 16 | | Department
shall utilize a uniform billing cycle throughout the | 17 | | State for the
long-term care providers.
| 18 | | (c) Notwithstanding any other provisions of this Code, the | 19 | | methodologies for reimbursement of nursing services as | 20 | | provided under this Article shall no longer be applicable for | 21 | | bills payable for nursing services rendered on or after a new | 22 | | reimbursement system based on the Resource Utilization Groups | 23 | | (RUGs) has been fully operationalized, which shall take effect | 24 | | for services provided on or after January 1, 2014. |
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| 1 | | (d) The new nursing services reimbursement methodology | 2 | | utilizing RUG-IV 48 grouper model, which shall be referred to | 3 | | as the RUGs reimbursement system, taking effect January 1, | 4 | | 2014, shall be based on the following: | 5 | | (1) The methodology shall be resident-driven, | 6 | | facility-specific, and cost-based. | 7 | | (2) Costs shall be annually rebased and case mix index | 8 | | quarterly updated. The nursing services methodology will | 9 | | be assigned to the Medicaid enrolled residents on record as | 10 | | of 30 days prior to the beginning of the rate period in the | 11 | | Department's Medicaid Management Information System (MMIS) | 12 | | as present on the last day of the second quarter preceding | 13 | | the rate period based upon the Assessment Reference Date of | 14 | | the Minimum Data Set (MDS). | 15 | | (3) Facility-specific staffing levels and wages paid. | 16 | | Regional wage adjustors based on the Health Service Areas | 17 | | (HSA) groupings and adjusters in effect on April 30, 2012 | 18 | | shall be included. | 19 | | (4) Case mix index shall be assigned to each resident | 20 | | class based on the Centers for Medicare and Medicaid | 21 | | Services staff time measurement study in effect on July 1, | 22 | | 2013, utilizing an index maximization approach. | 23 | | (5) The pool of funds available for distribution by | 24 | | case mix and the base facility rate shall be determined | 25 | | using the formula contained in subsection (d-1). | 26 | | (d-1) Calculation of base year Statewide RUG-IV nursing |
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| 1 | | base per diem rate , for dates of service beginning January 1, | 2 | | 2014 through December 31, 2016 . | 3 | | (1) Base rate spending pool shall be: | 4 | | (A) The base year resident days which are | 5 | | calculated by multiplying the number of Medicaid | 6 | | residents in each nursing home as indicated in the MDS | 7 | | data defined in paragraph (4) by 365. | 8 | | (B) Each facility's nursing component per diem in | 9 | | effect on July 1, 2012 shall be multiplied by | 10 | | subsection (A). | 11 | | (C) Thirteen million is added to the product of | 12 | | subparagraph (A) and subparagraph (B) to adjust for the | 13 | | exclusion of nursing homes defined in paragraph (5). | 14 | | (2) For each nursing home with Medicaid residents as | 15 | | indicated by the MDS data defined in paragraph (4), | 16 | | weighted days adjusted for case mix and regional wage | 17 | | adjustment shall be calculated. For each home this | 18 | | calculation is the product of: | 19 | | (A) Base year resident days as calculated in | 20 | | subparagraph (A) of paragraph (1). | 21 | | (B) The nursing home's regional wage adjustor | 22 | | based on the Health Service Areas (HSA) groupings and | 23 | | adjustors in effect on April 30, 2012. | 24 | | (C) Facility weighted case mix which is the number | 25 | | of Medicaid residents as indicated by the MDS data | 26 | | defined in paragraph (4) multiplied by the associated |
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| 1 | | case weight for the RUG-IV 48 grouper model using | 2 | | standard RUG-IV procedures for index maximization. | 3 | | (D) The sum of the products calculated for each | 4 | | nursing home in subparagraphs (A) through (C) above | 5 | | shall be the base year case mix, rate adjusted weighted | 6 | | days. | 7 | | (3) The Statewide RUG-IV nursing base per diem rate: | 8 | | (A) on January 1, 2014 shall be the quotient of the | 9 | | paragraph (1) divided by the sum calculated under | 10 | | subparagraph (D) of paragraph (2); and | 11 | | (B) on and after July 1, 2014, shall be the amount | 12 | | calculated under subparagraph (A) of this paragraph | 13 | | (3) plus $1.76. | 14 | | (4) Minimum Data Set (MDS) comprehensive assessments | 15 | | for Medicaid residents on the last day of the quarter used | 16 | | to establish the base rate. | 17 | | (5) Nursing facilities designated as of July 1, 2012 by | 18 | | the Department as "Institutions for Mental Disease" shall | 19 | | be excluded from all calculations under this subsection. | 20 | | The data from these facilities shall not be used in the | 21 | | computations described in paragraphs (1) through (4) above | 22 | | to establish the base rate. | 23 | | (e) Beginning July 1, 2014, the Department shall allocate | 24 | | funding in the amount up to $10,000,000 for per diem add-ons to | 25 | | the RUGS methodology for dates of service on and after July 1, | 26 | | 2014: |
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| 1 | | (1) $0.63 for each resident who scores in I4200 | 2 | | Alzheimer's Disease or I4800 non-Alzheimer's Dementia. | 3 | | (2) $2.67 for each resident who scores either a "1" or | 4 | | "2" in any items S1200A through S1200I and also scores in | 5 | | RUG groups PA1, PA2, BA1, or BA2. | 6 | | (e-1) (Blank). | 7 | | (e-2) For dates of services beginning January 1, 2014 | 8 | | through December 31, 2016 , the RUG-IV nursing component per | 9 | | diem for a nursing home shall be the product of the statewide | 10 | | RUG-IV nursing base per diem rate, the facility average case | 11 | | mix index, and the regional wage adjustor. Transition rates for | 12 | | services provided between January 1, 2014 and December 31, 2014 | 13 | | shall be as follows: | 14 | | (1) The transition RUG-IV per diem nursing rate for | 15 | | nursing homes whose rate calculated in this subsection | 16 | | (e-2) is greater than the nursing component rate in effect | 17 | | July 1, 2012 shall be paid the sum of: | 18 | | (A) The nursing component rate in effect July 1, | 19 | | 2012; plus | 20 | | (B) The difference of the RUG-IV nursing component | 21 | | per diem calculated for the current quarter minus the | 22 | | nursing component rate in effect July 1, 2012 | 23 | | multiplied by 0.88. | 24 | | (2) The transition RUG-IV per diem nursing rate for | 25 | | nursing homes whose rate calculated in this subsection | 26 | | (e-2) is less than the nursing component rate in effect |
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| 1 | | July 1, 2012 shall be paid the sum of: | 2 | | (A) The nursing component rate in effect July 1, | 3 | | 2012; plus | 4 | | (B) The difference of the RUG-IV nursing component | 5 | | per diem calculated for the current quarter minus the | 6 | | nursing component rate in effect July 1, 2012 | 7 | | multiplied by 0.13. | 8 | | (e-3) Calculation of facility-specific RUG-IV nursing | 9 | | component per diem rate for dates of service beginning January | 10 | | 1, 2017. | 11 | | (1) The facility-specific RUG-IV nursing component per | 12 | | diem rate must be the product of: | 13 | | (A) The Statewide RUG-IV base rate of $85.25. | 14 | | (B) The staffing and wage adjuster which is | 15 | | assigned per facility based on the facility's specific | 16 | | total per resident per day staffing wage cost as | 17 | | defined in paragraph (2) of this subsection. For levels | 18 | | defined in paragraph (3) of this subsection, the | 19 | | staffing wage adjuster is: | 20 | | (i) 0.80 for a facility with a total per | 21 | | resident per day staffing wage cost less than level | 22 | | 1, or a facility whose staffing level is below the | 23 | | intermediate care minimum required under Section | 24 | | 3-202.05 of the Nursing Home Care Act even if the | 25 | | facility has a total per resident per day staffing | 26 | | wage cost greater than or equal to level 1; |
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| 1 | | (ii) 1.22 for a facility with a total per | 2 | | resident per day staffing wage cost greater than or | 3 | | equal to level 1 but less than level 2; | 4 | | (iii) 1.42 for a facility with a total per | 5 | | resident per day staffing wage cost greater than or | 6 | | equal to level 2 but less than level 3; | 7 | | (iv) 1.45 for a facility with a total per | 8 | | resident per day staffing wage cost greater than or | 9 | | equal to level 3; or | 10 | | (v) 0.80 for a facility without data necessary | 11 | | to calculate the facility's specific total per | 12 | | resident per day staffing wage cost as defined in | 13 | | paragraph (2) of this subsection. | 14 | | (C) The facility weighted case mix, which is the | 15 | | number of Medicaid residents as indicated by the | 16 | | Minimum Data Set (MDS) data defined in paragraph (4) of | 17 | | this subsection multiplied by the associated case | 18 | | weight for the RUG-IV 48 grouper model using standard | 19 | | RUG-IV procedures for index maximization. | 20 | | (D) The ratio of actual staffing hours to total | 21 | | expected staffing hours adjuster which is assigned | 22 | | based on each facility's ratio as defined in paragraph | 23 | | (5) of this subsection. The facilities are divided into | 24 | | 4 quartiles sorted from lowest to highest based on the | 25 | | facility's ratio. The quartile with the lowest ratios | 26 | | is quartile 1 and the quartile with the highest ratios |
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| 1 | | is quartile 4 with quartile 2 and quartile 3 assigned | 2 | | based on the ratios in those quartiles in relation to | 3 | | lowest and highest quartiles. Facilities without | 4 | | reported data are assigned to quartile 3. The quartiles | 5 | | are calculated quarterly during regular rate updates. | 6 | | The adjuster for each quartile is as follows: | 7 | | (i) 0.65 for facilities in quartile 1; | 8 | | (ii) the ratio defined in paragraph (5) of this | 9 | | subsection for facilities in quartile 2 and 3; or | 10 | | (iii) 1.00 for facilities in quartile 4. | 11 | | (2) The staffing and wage adjuster under subparagraph | 12 | | (B) of paragraph (1) of this subsection must be updated | 13 | | each quarter using the staffing hours and wage data from | 14 | | Payroll Benefit Journal data collected by the Centers for | 15 | | Medicare and Medicaid Services for the same time period of | 16 | | MDS data used to calculate the RUG-IV acuity case weight. | 17 | | For the purposes of this Section, each facility's "total | 18 | | per resident per day staffing wage cost" is calculated by | 19 | | summing: | 20 | | (A) The product of registered nurses' hours worked | 21 | | per resident day multiplied by the reported hourly | 22 | | wage. For the Director of Nursing only the number of | 23 | | hours allowed under Section 3-202.05 of the Nursing | 24 | | Home Care Act for the calculation of staffing ratios | 25 | | may be included; plus | 26 | | (B) The product of licensed practical nurses' |
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| 1 | | worked hours per resident day multiplied by the | 2 | | reported hourly wage; plus | 3 | | (C) The product of certified nurse assistants' | 4 | | hours worked per resident day multiplied by the | 5 | | reported hourly wage; plus | 6 | | (D) For all other staff considered direct care | 7 | | staff under staffing ratios described in Section | 8 | | 3-202.05 of the Nursing Home Care Act, the product of | 9 | | each remaining direct care staff type hours worked per | 10 | | resident day multiplied by the reported hourly wage for | 11 | | the direct care staff category at the same levels | 12 | | allowed under the staffing ratios under Section | 13 | | 3-202.05 of the Nursing Home Care Act. | 14 | | (3) The levels used to assign the staffing and wage | 15 | | adjuster under subparagraph (B) of paragraph (1) of this | 16 | | subsection shall be calculated using the staffing ratios | 17 | | required under Section 3-202.05 of the Nursing Home Care | 18 | | Act multiplied by the Illinois mean hourly wage for the | 19 | | equivalent occupational code and title assigned by the U.S. | 20 | | Bureau of Labor Statistics and reported in the May 2014 | 21 | | State Occupational Employment and Wage Estimates for | 22 | | Illinois. The Department may, as established by rule, use | 23 | | more current data from the same data set when made | 24 | | available. The levels are: | 25 | | (A) Level 1 is equal to the sum of: | 26 | | (i) The product of 10% of the minimum staffing |
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| 1 | | hours per resident day for intermediate care under | 2 | | Section 3-202.05 of the Nursing Home Care Act | 3 | | multiplied by the Illinois mean hourly wage for | 4 | | registered nurses occupation code 29-1141 from the | 5 | | U.S. Bureau of Labor Statistics data set described | 6 | | in paragraph (3) of this subsection; plus | 7 | | (ii) The product of 15% of the minimum staffing | 8 | | hours per resident day for intermediate care under | 9 | | Section 3-202.05 of the Nursing Home Care Act | 10 | | multiplied by the Illinois mean hourly wage for | 11 | | licensed practical nurses occupation code 29-2061 | 12 | | from the U.S.
Bureau of Labor Statistics data set | 13 | | described in paragraph (3) of this subsection; | 14 | | plus | 15 | | (iii) The product of 75% of the minimum | 16 | | staffing hours per resident day for intermediate | 17 | | care under Section 3-202.05 of the Nursing Home | 18 | | Care Act multiplied by the Illinois mean hourly | 19 | | wage for nursing assistants occupation code | 20 | | 31-1014 from the U.S. Bureau of Labor Statistics | 21 | | data set described in paragraph (3) of this | 22 | | subsection. | 23 | | (B) Level 2 is equal to the sum of: | 24 | | (i) The product of 10% of the minimum staffing | 25 | | hours per resident day for skilled care under | 26 | | Section 3-202.05 of the Nursing Home Care Act |
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| 1 | | multiplied by the Illinois mean hourly wage for | 2 | | registered nurses occupation code 29-1141 from the | 3 | | U.S. Bureau of Labor Statistics data set described | 4 | | in paragraph (3) of this subsection; plus | 5 | | (ii) The product of 15% of the minimum staffing | 6 | | hours per resident day for skilled care under | 7 | | Section 3-202.05 of the Nursing Home Care Act | 8 | | multiplied by the Illinois mean hourly wage for | 9 | | licensed practical nurses occupation code 29-2061 | 10 | | from the U.S. Bureau of Labor Statistics set | 11 | | described in paragraph (3) of this subsection; | 12 | | plus | 13 | | (iii) The product of 75% of the minimum | 14 | | staffing hours per resident day for skilled care | 15 | | under Section 3-202.05 of the Nursing Home Care Act | 16 | | multiplied by the Illinois mean hourly wage for | 17 | | nursing assistants occupation code 31-1014 from | 18 | | the U.S. Bureau of Labor Statistics data set | 19 | | described in paragraph (3) of this subsection. | 20 | | (C) Level 3 is equal to the sum of: | 21 | | (i) The product of .84 staffing hours per | 22 | | resident day multiplied by the Illinois mean | 23 | | hourly wage for registered nurses occupation code | 24 | | 29-1141 from the U.S. Bureau of Labor Statistics | 25 | | data set described in paragraph (3) of this | 26 | | subsection; plus |
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| 1 | | (ii) The product of .84 staffing hours per | 2 | | resident day multiplied by the Illinois mean | 3 | | hourly wage for licensed practical nurses | 4 | | occupation code 29-2061 from the U.S. Bureau of | 5 | | Labor Statistics data set described in paragraph | 6 | | (3) of this subsection; plus | 7 | | (iii) The product of 2.46 staffing hours per | 8 | | resident day multiplied by the Illinois mean | 9 | | hourly wage for nursing assistants occupation code | 10 | | 31-1014 from the U.S. Bureau of Labor Statistics | 11 | | data set described in paragraph (3) of this | 12 | | subsection. | 13 | | (4) Minimum Data Set comprehensive assessments for | 14 | | Medicaid residents on the last day of the quarter used to | 15 | | establish the rate. | 16 | | (5) The facility-specific total ratio of actual | 17 | | staffing hours to total expected staffing hours for the | 18 | | assigned resident specific case weight must be updated each | 19 | | quarter using the staffing hours and wage data from Payroll | 20 | | Benefit Journal data collected by the Centers for Medicare | 21 | | and Medicaid Services for the same time period of MDS data | 22 | | used to calculate the RUG-IV acuity case weight. For each | 23 | | facility the Department must calculate the total hours | 24 | | worked per resident day for direct care staff allowed by | 25 | | the staffing ratios under Section 3-202.05 of the Nursing | 26 | | Home Care Act and divide that value by the sum of staffing |
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| 1 | | hours per resident day assigned to each resident based on | 2 | | the sum of the Resident Specific Time and Direct | 3 | | Non-Resident Specific Time for the resident's RUG-IV | 4 | | group. This is the same methodology for the Medicare 5-star | 5 | | rating program calculation of the expected staffing hours | 6 | | per resident day used by the Centers for Medicare
and | 7 | | Medicaid Services, except that the Centers for Medicare
and | 8 | | Medicaid Services uses RUG-III groupings. | 9 | | (6) If the Payroll Benefit Journal data collected by | 10 | | the Centers for Medicare and Medicaid Services is not | 11 | | available, the Department must use the most recent cost | 12 | | reporting data reported to the Department and the most | 13 | | recent survey data posted to the Centers for Medicare and | 14 | | Medicaid Services' Nursing Home Compare website. The | 15 | | Department must use the Payroll Benefit Journal data | 16 | | collected by the Centers for Medicare and Medicaid Services | 17 | | once the data is available. | 18 | | (e-4) Budget stability beginning January 1, 2017. | 19 | | (1) Beginning January 1, 2017 and annually thereafter, | 20 | | the Department may adjust, by administrative rule and | 21 | | within the parameters established under this subsection | 22 | | (e-4), the staffing and wage adjuster described in | 23 | | subparagraph (B) of paragraph (1) of subsection (e-3) and | 24 | | the ratio of actual staffing hours to the total expected | 25 | | staffing hours adjuster described in subparagraph (D) of | 26 | | paragraph (1) of subsection (e-3) for the purpose of |
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| 1 | | keeping liability created by the facility-specific RUG-IV | 2 | | nursing component per diem rates stable as defined in | 3 | | paragraph (2) and paragraph (3) of this subsection (e-4). | 4 | | (2) Budget stability for facility-specific RUG-IV | 5 | | nursing component per diem rates effective January 1, 2017. | 6 | | If the aggregate budget stability ratio calculated under | 7 | | paragraph (4) of this subsection is greater than 0.96, then | 8 | | the Department must adjust one or both of the adjusters | 9 | | specified in paragraph (1) of this subsection in order to | 10 | | decrease the ratio to no less than 0.96. | 11 | | (3) Budget stability for facility-specific RUG-IV | 12 | | nursing component per diem rates effective January 1, 2018 | 13 | | and annually thereafter. If the aggregate budget stability | 14 | | ratio calculated under paragraph (4) of this subsection is | 15 | | between 0.99 and 1.01, the Department must not make any | 16 | | adjustments. If the aggregate budget stability ratio | 17 | | calculated under paragraph (4) of this subsection is less | 18 | | than 0.99, then the Department must adjust one or both of | 19 | | the adjusters specified in paragraph (1) of this subsection | 20 | | in order to increase the ratio to at least 0.99. If the | 21 | | aggregate budget stability ratio calculated under | 22 | | paragraph (4) of this subsection is greater than 1.01, then | 23 | | the Department must adjust one or both of the adjusters | 24 | | specified in paragraph (1) of this subsection in order to | 25 | | decrease the ratio to at least 1.01, but no less than 1.00. | 26 | | (4) For the purposes of this Section, the aggregate |
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| 1 | | budget stability ratio calculated with the numerator | 2 | | described in subparagraph (A) of this paragraph (4) divided | 3 | | by the denominator described in subparagraph (B) of this | 4 | | paragraph (4) is as follows: | 5 | | (A) Numerator equal to the sum of the following | 6 | | products: | 7 | | (i) the product of the number of Medicaid | 8 | | residents in each nursing home as indicated in the | 9 | | MDS data defined in paragraph (4) of subsection | 10 | | (e-3) multiplied by 365; then multiplied by | 11 | | (ii) each nursing home's specific rate under | 12 | | paragraph (1) of subsection (e-3). This rate does | 13 | | not include the per diem add-ons defined in | 14 | | subsection (e) of this Section. | 15 | | (B) Denominator equal to the sum of the following | 16 | | products: | 17 | | (i) the product of the number of Medicaid | 18 | | residents in each nursing home as indicated in the | 19 | | MDS data defined in paragraph (4) of subsection | 20 | | (e-3) multiplied by 365; then multiplied by | 21 | | (ii) each nursing home's specific rate | 22 | | effective July 1, 2015 under subsection (e-2). | 23 | | This rate does not include the per diem add-ons | 24 | | defined in subsection (e) of this Section. | 25 | | (5) If adjustments are necessary under this subsection | 26 | | (e-4), the staffing and wage adjuster described in |
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| 1 | | subparagraph (B) of paragraph (1) of subsection (e-3) must | 2 | | be adjusted within the following parameters: | 3 | | (A) the adjuster for facilities with a total per | 4 | | resident per day staffing wage cost less than level 1 | 5 | | must never be greater than 0.80; | 6 | | (B) the adjuster for facilities with a total per | 7 | | resident per day staffing wage cost less than level 1 | 8 | | must be lower than the adjusters for the other levels; | 9 | | (C) the adjuster for facilities with a total per | 10 | | resident per day staffing wage cost less than level 1 | 11 | | must generate an aggregate cost coverage for nursing | 12 | | homes qualifying for that adjuster less than or equal | 13 | | to 70% using the most recent cost data from cost | 14 | | reports filed with the Department. The cost coverage | 15 | | for the nursing homes qualifying for that adjuster must | 16 | | have the lowest cost coverage as compared to the other | 17 | | 3 groups; | 18 | | (D) the adjusters for the middle 2 levels must | 19 | | generate the best possible aggregate cost coverage for | 20 | | nursing homes qualifying for those adjusters of all the | 21 | | adjusters using the most recent cost data from cost | 22 | | reports filed with the Department; and | 23 | | (E) the adjuster for facilities with a total per | 24 | | resident per day staffing wage cost greater than level | 25 | | 4 must generate an aggregate cost coverage for nursing | 26 | | homes qualifying for that adjuster less than or equal |
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| 1 | | to 80% using the most recent cost data from cost | 2 | | reports filed with the Department. | 3 | | (F) Any limitations in this paragraph (5) based on | 4 | | cost coverage must use the most recent cost data from | 5 | | cost reports filed with the Department and must be | 6 | | calculated after any adjustments have been made to the | 7 | | ratio of actual staffing hours to total expected | 8 | | staffing hours adjuster described in subparagraph (D) | 9 | | of paragraph (1) of subsection (e-3) and limited by | 10 | | paragraph (6) of this subsection (e-4). | 11 | | (6) If adjustments are necessary under this subsection | 12 | | (e-4), the ratio of actual staffing hours to total expected | 13 | | staffing hours adjuster described in subparagraph (D) of | 14 | | paragraph (1) of subsection (e-3) must be adjusted within | 15 | | the following parameters: | 16 | | (A) the adjuster for quartile 4 which has the best | 17 | | acuity based staffing ratio must never be less than | 18 | | 1.00; | 19 | | (B) the adjuster for quartile 1 must be the | 20 | | smallest of all 4 quartile adjusters and must never be | 21 | | greater than 0.65; | 22 | | (C) the Department may set a specific adjuster for | 23 | | quartile 2 and quartile 3 as opposed to the | 24 | | facility-specific ratio defined in paragraph (5) of | 25 | | subsection (e-3) which is allowed under subparagraph | 26 | | (D) of paragraph (1) of subsection (e-3). If the |
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| 1 | | Department sets a specific adjuster for quartile 2 or | 2 | | quartile 3, then the adjuster for quartile 3 must not | 3 | | be greater than the adjuster for quartile 4 or less | 4 | | than the adjuster for quartile 2. The adjuster for | 5 | | quartile 2 must not be greater than the adjuster for | 6 | | quartile 3 or less than the adjuster for quartile 1; | 7 | | and | 8 | | (D) no quartile may have an adjuster greater than | 9 | | 1.00. | 10 | | (7) For the purposes of this Section, cost coverage for | 11 | | a facility is the facility-specific RUG-IV nursing | 12 | | component per diem rate divided by the healthcare program | 13 | | cost per day. The healthcare program cost per day is | 14 | | calculated using data from cost reports submitted to the | 15 | | Department as required under the Illinois Public Aid Code | 16 | | and the Department's administrative rules. The Department | 17 | | may update the cost report references in this paragraph by | 18 | | administrative rule should the Department's cost report be | 19 | | altered, as long as the updated references result in | 20 | | identification of the identical or equivalent data and does | 21 | | not materially change the resulting calculations. If the | 22 | | Department has made changes from an audit, the Department | 23 | | may use column 10 instead of column 8 of the respective | 24 | | cost report lines cited in this paragraph (7) if the | 25 | | information is made publicly available at the time of | 26 | | making any calculations required in this Section. The |
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| 1 | | healthcare program cost per day is the quotient of: | 2 | | (A) the sum of the following costs as reported on | 3 | | schedule V. of the Department's cost report; | 4 | | (i) the total adjusted health care and | 5 | | programs costs as reported on line 16 column 8; | 6 | | plus | 7 | | (ii) the total adjusted provider participation | 8 | | fee costs as reported on line 42 column 8; plus | 9 | | (iii) the total allocated cost of employee | 10 | | benefits for health care employees calculated as | 11 | | the total adjusted health care and programs salary | 12 | | and wage costs as reported on line 16 column 1 | 13 | | divided by the product of the grand total salary | 14 | | and wages as reported on line 45 column 1 | 15 | | multiplied by the total adjusted employee benefits | 16 | | and payroll taxes as report on line 22 column 8; | 17 | | (B) divided by the total patient days reported on | 18 | | schedule III line 14 column 5 of the Department's cost | 19 | | report. | 20 | | (f) Notwithstanding any other provision of this Code, on | 21 | | and after July 1, 2012, reimbursement rates associated with the | 22 | | nursing or support components of the current nursing facility | 23 | | rate methodology shall not increase beyond the level effective | 24 | | May 1, 2011 until a new reimbursement system based on the RUGs | 25 | | IV 48 grouper model has been fully operationalized. | 26 | | (g) Notwithstanding any other provision of this Code, on |
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| 1 | | and after July 1, 2012, for facilities not designated by the | 2 | | Department of Healthcare and Family Services as "Institutions | 3 | | for Mental Disease", rates effective May 1, 2011 shall be | 4 | | adjusted as follows: | 5 | | (1) Individual nursing rates for residents classified | 6 | | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | 7 | | ending March 31, 2012 shall be reduced by 10%; | 8 | | (2) Individual nursing rates for residents classified | 9 | | in all other RUG IV groups shall be reduced by 1.0%; | 10 | | (3) Facility rates for the capital and support | 11 | | components shall be reduced by 1.7%. | 12 | | (h) Notwithstanding any other provision of this Code, on | 13 | | and after July 1, 2012, nursing facilities designated by the | 14 | | Department of Healthcare and Family Services as "Institutions | 15 | | for Mental Disease" and "Institutions for Mental Disease" that | 16 | | are facilities licensed under the Specialized Mental Health | 17 | | Rehabilitation Act of 2013 shall have the nursing, | 18 | | socio-developmental, capital, and support components of their | 19 | | reimbursement rate effective May 1, 2011 reduced in total by | 20 | | 2.7%. | 21 | | (i) On and after July 1, 2014, the reimbursement rates for | 22 | | the support component of the nursing facility rate for | 23 | | facilities licensed under the Nursing Home Care Act as skilled | 24 | | or intermediate care facilities shall be the rate in effect on | 25 | | June 30, 2014 increased by 8.17%. | 26 | | (j) The Department may adopt rules in accordance with the |
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| 1 | | Illinois Administrative Procedure Act to implement this | 2 | | Section. However, the requirements under this Section must be | 3 | | implemented by the Department even if the Department has not | 4 | | adopted rules by the implementation date of January 1, 2017. | 5 | | (Source: P.A. 98-104, Article 6, Section 6-240, eff. 7-22-13; | 6 | | 98-104, Article 11, Section 11-35, eff. 7-22-13; 98-651, eff. | 7 | | 6-16-14; 98-727, eff. 7-16-14; 98-756, eff. 7-16-14; 99-78, | 8 | | eff. 7-20-15.)
| 9 | | Section 99. Effective date. This Act takes effect upon | 10 | | becoming law.".
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