SB1696 EngrossedLRB101 09721 KTG 54821 b

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.
14    (c) Notwithstanding any other provisions of this Code, the
15methodologies for reimbursement of nursing services as
16provided under this Article shall no longer be applicable for
17bills payable for nursing services rendered on or after a new
18reimbursement system based on the Resource Utilization Groups
19(RUGs) has been fully operationalized, which shall take effect
20for services provided on or after January 1, 2014.
21    (d) The new nursing services reimbursement methodology
22utilizing RUG-IV 48 grouper model, which shall be referred to
23as the RUGs reimbursement system, taking effect January 1,



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12014, 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 based upon the Assessment Reference Date of
11    the Minimum Data Set (MDS).
12        (3) Regional wage adjustors based on the Health Service
13    Areas (HSA) groupings and adjusters in effect on April 30,
14    2012 shall be included.
15        (4) Case mix index shall be assigned to each resident
16    class based on the Centers for Medicare and Medicaid
17    Services staff time measurement study in effect on July 1,
18    2013, utilizing an index maximization approach.
19        (5) The pool of funds available for distribution by
20    case mix and the base facility rate shall be determined
21    using the formula contained in subsection (d-1).
22    (d-1) Calculation of base year Statewide RUG-IV nursing
23base per diem rate.
24        (1) Base rate spending pool shall be:
25            (A) The base year resident days which are
26        calculated by multiplying the number of Medicaid



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1        residents in each nursing home as indicated in the MDS
2        data defined in paragraph (4) by 365.
3            (B) Each facility's nursing component per diem in
4        effect on July 1, 2012 shall be multiplied by
5        subsection (A).
6            (C) Thirteen million is added to the product of
7        subparagraph (A) and subparagraph (B) to adjust for the
8        exclusion of nursing homes defined in paragraph (5).
9        (2) For each nursing home with Medicaid residents as
10    indicated by the MDS data defined in paragraph (4),
11    weighted days adjusted for case mix and regional wage
12    adjustment shall be calculated. For each home this
13    calculation is the product of:
14            (A) Base year resident days as calculated in
15        subparagraph (A) of paragraph (1).
16            (B) The nursing home's regional wage adjustor
17        based on the Health Service Areas (HSA) groupings and
18        adjustors in effect on April 30, 2012.
19            (C) Facility weighted case mix which is the number
20        of Medicaid residents as indicated by the MDS data
21        defined in paragraph (4) multiplied by the associated
22        case weight for the RUG-IV 48 grouper model using
23        standard RUG-IV procedures for index maximization.
24            (D) The sum of the products calculated for each
25        nursing home in subparagraphs (A) through (C) above
26        shall be the base year case mix, rate adjusted weighted



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1        days.
2        (3) The Statewide RUG-IV nursing base per diem rate:
3            (A) on January 1, 2014 shall be the quotient of the
4        paragraph (1) divided by the sum calculated under
5        subparagraph (D) of paragraph (2); and
6            (B) on and after July 1, 2014, shall be the amount
7        calculated under subparagraph (A) of this paragraph
8        (3) plus $1.76.
9        (4) Minimum Data Set (MDS) comprehensive assessments
10    for Medicaid residents on the last day of the quarter used
11    to establish the base rate.
12        (5) Nursing facilities designated as of July 1, 2012 by
13    the Department as "Institutions for Mental Disease" shall
14    be excluded from all calculations under this subsection.
15    The data from these facilities shall not be used in the
16    computations described in paragraphs (1) through (4) above
17    to establish the base rate.
18    (e) Beginning July 1, 2014, the Department shall allocate
19funding in the amount up to $10,000,000 for per diem add-ons to
20the RUGS methodology for dates of service on and after July 1,
22        (1) $0.63 for each resident who scores in I4200
23    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
24        (2) $2.67 for each resident who scores either a "1" or
25    "2" in any items S1200A through S1200I and also scores in
26    RUG groups PA1, PA2, BA1, or BA2.



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1    (e-1) (Blank).
2    (e-2) For dates of services beginning January 1, 2014, the
3RUG-IV nursing component per diem for a nursing home shall be
4the product of the statewide RUG-IV nursing base per diem rate,
5the facility average case mix index, and the regional wage
6adjustor. Transition rates for services provided between
7January 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    (f) Notwithstanding any other provision of this Code, on
3and after July 1, 2012, reimbursement rates associated with the
4nursing or support components of the current nursing facility
5rate methodology shall not increase beyond the level effective
6May 1, 2011 until a new reimbursement system based on the RUGs
7IV 48 grouper model has been fully operationalized.
8    (g) Notwithstanding any other provision of this Code, on
9and after July 1, 2012, for facilities not designated by the
10Department of Healthcare and Family Services as "Institutions
11for Mental Disease", rates effective May 1, 2011 shall be
12adjusted as follows:
13        (1) Individual nursing rates for residents classified
14    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
15    ending March 31, 2012 shall be reduced by 10%;
16        (2) Individual nursing rates for residents classified
17    in all other RUG IV groups shall be reduced by 1.0%;
18        (3) Facility rates for the capital and support
19    components shall be reduced by 1.7%.
20    (h) Notwithstanding any other provision of this Code, on
21and after July 1, 2012, nursing facilities designated by the
22Department of Healthcare and Family Services as "Institutions
23for Mental Disease" and "Institutions for Mental Disease" that
24are facilities licensed under the Specialized Mental Health
25Rehabilitation Act of 2013 shall have the nursing,
26socio-developmental, capital, and support components of their



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1reimbursement rate effective May 1, 2011 reduced in total by
3    (i) On and after July 1, 2014, the reimbursement rates for
4the support component of the nursing facility rate for
5facilities licensed under the Nursing Home Care Act as skilled
6or intermediate care facilities shall be the rate in effect on
7June 30, 2014 increased by 8.17%.
8    (j) During the first quarter of State Fiscal Year 2020, the
9Department of Healthcare of Family Services must convene a
10technical advisory group consisting of members of all trade
11associations representing Illinois skilled nursing providers
12to discuss changes necessary with federal implementation of
13Medicare's Patient-Driven Payment Model. Implementation of
14Medicare's Patient-Driven Payment Model shall, by September 1,
152020, end the collection of the MDS data that is necessary to
16maintain the current RUG-IV Medicaid payment methodology. The
17technical advisory group must consider a revised reimbursement
18methodology that takes into account transparency,
19accountability, actual staffing as reported under the
20federally required Payroll Based Journal system, changes to the
21minimum wage, adequacy in coverage of the cost of care, and a
22quality component that rewards quality improvements.
23(Source: P.A. 98-104, Article 6, Section 6-240, eff. 7-22-13;
2498-104, Article 11, Section 11-35, eff. 7-22-13; 98-651, eff.
256-16-14; 98-727, eff. 7-16-14; 98-756, eff. 7-16-14; 99-78,
26eff. 7-20-15.)



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1    Section 99. Effective date. This Act takes effect upon
2becoming law.