Illinois General Assembly - Full Text of SB1773
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Full Text of SB1773  100th General Assembly




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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 Public Aid Code is amended by
5changing 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
9Section 5-5.1 of this Act shall receive the same rate of
10payment for similar services.
11    (b) It shall be a matter of State policy that the Illinois
12Department shall utilize a uniform billing cycle throughout the
13State for the long-term care providers. The Department shall
14provide an update on the status of payments from both the
15General Revenue Fund and the Long-Term Care Provider Fund for
16expedited and non-expedited facilities by schedule. The
17Department may provide the information monthly electronically,
18post it on the Department's website, or provide it upon request
19in compliance with this requirement.
20    (c) Notwithstanding any other provisions of this Code, the
21methodologies for reimbursement of nursing services as
22provided under this Article shall no longer be applicable for
23bills payable for nursing services rendered on or after a new



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1reimbursement system based on the Resource Utilization Groups
2(RUGs) has been fully operationalized, which shall take effect
3for services provided on or after January 1, 2014.
4    (d) The new nursing services reimbursement methodology
5utilizing RUG-IV 48 grouper model, which shall be referred to
6as the RUGs reimbursement system, taking effect January 1,
72014, shall be based on the following:
8        (1) The methodology shall be resident-driven,
9    facility-specific, and cost-based.
10        (2) Costs shall be annually rebased and case mix index
11    quarterly updated. The nursing services methodology will
12    be assigned to the Medicaid enrolled residents on record as
13    of 30 days prior to the beginning of the rate period in the
14    Department's Medicaid Management Information System (MMIS)
15    as present on the last day of the second quarter preceding
16    the rate period based upon the Assessment Reference Date of
17    the Minimum Data Set (MDS).
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
3base 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:
9            (A) on January 1, 2014 shall be the quotient of the
10        paragraph (1) divided by the sum calculated under
11        subparagraph (D) of paragraph (2); and
12            (B) on and after July 1, 2014, shall be the amount
13        calculated under subparagraph (A) of this paragraph
14        (3) plus $1.76.
15        (4) Minimum Data Set (MDS) comprehensive assessments
16    for Medicaid residents on the last day of the quarter used
17    to establish the base rate.
18        (5) Nursing facilities designated as of July 1, 2012 by
19    the Department as "Institutions for Mental Disease" shall
20    be excluded from all calculations under this subsection.
21    The data from these facilities shall not be used in the
22    computations described in paragraphs (1) through (4) above
23    to establish the base rate.
24    (e) Beginning July 1, 2014, the Department shall allocate
25funding in the amount up to $10,000,000 for per diem add-ons to
26the RUGS methodology for dates of service on and after July 1,



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2        (1) $0.63 for each resident who scores in I4200
3    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
4        (2) $2.67 for each resident who scores either a "1" or
5    "2" in any items S1200A through S1200I and also scores in
6    RUG groups PA1, PA2, BA1, or BA2.
7    (e-1) (Blank).
8    (e-2) For dates of services beginning January 1, 2014, the
9RUG-IV nursing component per diem for a nursing home shall be
10the product of the statewide RUG-IV nursing base per diem rate,
11the facility average case mix index, and the regional wage
12adjustor. Transition rates for services provided between
13January 1, 2014 and December 31, 2014 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    (f) Notwithstanding any other provision of this Code, on
9and after July 1, 2012, reimbursement rates associated with the
10nursing or support components of the current nursing facility
11rate methodology shall not increase beyond the level effective
12May 1, 2011 until a new reimbursement system based on the RUGs
13IV 48 grouper model has been fully operationalized.
14    (g) Notwithstanding any other provision of this Code, on
15and after July 1, 2012, for facilities not designated by the
16Department of Healthcare and Family Services as "Institutions
17for Mental Disease", rates effective May 1, 2011 shall be
18adjusted as follows:
19        (1) Individual nursing rates for residents classified
20    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
21    ending March 31, 2012 shall be reduced by 10%;
22        (2) Individual nursing rates for residents classified
23    in all other RUG IV groups shall be reduced by 1.0%;
24        (3) Facility rates for the capital and support
25    components shall be reduced by 1.7%.
26    (h) Notwithstanding any other provision of this Code, on



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1and after July 1, 2012, nursing facilities designated by the
2Department of Healthcare and Family Services as "Institutions
3for Mental Disease" and "Institutions for Mental Disease" that
4are facilities licensed under the Specialized Mental Health
5Rehabilitation Act of 2013 shall have the nursing,
6socio-developmental, capital, and support components of their
7reimbursement rate effective May 1, 2011 reduced in total by
9    (i) On and after July 1, 2014, the reimbursement rates for
10the support component of the nursing facility rate for
11facilities licensed under the Nursing Home Care Act as skilled
12or intermediate care facilities shall be the rate in effect on
13June 30, 2014 increased by 8.17%.
14(Source: P.A. 98-104, Article 6, Section 6-240, eff. 7-22-13;
1598-104, Article 11, Section 11-35, eff. 7-22-13; 98-651, eff.
166-16-14; 98-727, eff. 7-16-14; 98-756, eff. 7-16-14; 99-78,
17eff. 7-20-15.)
18    Section 99. Effective date. This Act takes effect upon
19becoming law.