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91_HB2356
LRB9104670DJcd
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 5-5.4 and repealing Article V-E.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Section 5-5.4 as follows:
7 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
8 Sec. 5-5.4. Standards of Payment - Department of Public
9 Aid. The Department of Public Aid shall develop standards of
10 payment of skilled nursing and intermediate care services in
11 facilities providing such services under this Article which:
12 (1) Provides for the determination of a facility's
13 payment for skilled nursing and intermediate care services on
14 a prospective basis. The amount of the payment rate for all
15 nursing facilities certified under the medical assistance
16 program shall be prospectively established annually on the
17 basis of historical, financial, and statistical data
18 reflecting actual costs from prior years, which shall be
19 applied to the current rate year and updated for inflation,
20 except that the capital cost element for newly constructed
21 facilities shall be based upon projected budgets. The
22 annually established payment rate shall take effect on July 1
23 in 1984 and subsequent years. Rate increases shall be
24 provided annually thereafter on July 1 in 1984 and on each
25 subsequent July 1 in the following years, except that no rate
26 increase and no update for inflation shall be provided on or
27 after July 1, 1994 and before July 1, 1999, unless
28 specifically provided for in this Section. For facilities
29 licensed by the Department of Public Health under the Nursing
30 Home Care Act as Intermediate Care for the Developmentally
31 Disabled facilities or Long Term Care for Under Age 22
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1 facilities, the rates taking effect on July 1, 1998 shall
2 include an increase of 3%. For facilities licensed by the
3 Department of Public Health under the Nursing Home Care Act
4 as Skilled Nursing facilities or Intermediate Care
5 facilities, the rates taking effect on July 1, 1998 shall
6 include an increase of 3% plus $1.10 per resident-day, as
7 defined by the Department. Rates established effective each
8 July 1 shall govern payment for services rendered throughout
9 that fiscal year, except that rates established on July 1,
10 1996 shall be increased by 6.8% for services provided on or
11 after January 1, 1997, and except that for those facilities
12 with rates less than the actual, audited costs, rates
13 established on July 1, 1999 shall be increased to no less
14 than the lower of the average costs in the facility's
15 geographic area as defined by the Department or the
16 facility's actual audited, adjusted costs. In no case shall
17 a facility's July 1, 1999 rate be less than its July 1, 1998
18 rate. The repeal of Article V-E by this amendatory Act of
19 the 91st General Assembly shall have no effect on the rates
20 paid to facilities. Such rates will be based upon the rates
21 calculated for the year beginning July 1, 1990, and for
22 subsequent years thereafter shall be based on the facility
23 cost reports for the facility fiscal year ending at any point
24 in time during the previous calendar year, updated to the
25 midpoint of the rate year. The cost report shall be on file
26 with the Department no later than April 1 of the current rate
27 year. Should the cost report not be on file by April 1, the
28 Department shall base the rate on the latest cost report
29 filed by each skilled care facility and intermediate care
30 facility, updated to the midpoint of the current rate year.
31 In determining rates for services rendered on and after July
32 1, 1985, fixed time shall not be computed at less than zero.
33 The Department shall not make any alterations of regulations
34 which would reduce any component of the Medicaid rate to a
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1 level below what that component would have been utilizing in
2 the rate effective on July 1, 1984.
3 (2) Shall take into account the actual costs incurred by
4 facilities in providing services for recipients of skilled
5 nursing and intermediate care services under the medical
6 assistance program.
7 (3) Shall take into account the medical and
8 psycho-social characteristics and needs of the patients.
9 (4) Shall take into account the actual costs incurred by
10 facilities in meeting licensing and certification standards
11 imposed and prescribed by the State of Illinois, any of its
12 political subdivisions or municipalities and by the United
13 States Department of Health, Education and Welfare pursuant
14 to Title XIX of the Social Security Act.
15 The Department of Public Aid shall develop precise
16 standards for payments to reimburse nursing facilities for
17 any utilization of appropriate rehabilitative personnel for
18 the provision of rehabilitative services which is authorized
19 by federal regulations, including reimbursement for services
20 provided by qualified therapists or qualified assistants, and
21 which is in accordance with accepted professional practices.
22 Reimbursement also may be made for utilization of other
23 supportive personnel under appropriate supervision.
24 (Source: P.A. 89-21, eff. 7-1-95; 89-499, eff. 6-28-96; 90-9,
25 eff. 7-1-97; 90-588, eff. 7-1-98.)
26 (305 ILCS 5/Art. V-E rep.)
27 Section 6. The Illinois Public Aid Code is amended by
28 repealing Article V-E.