State of Illinois
91st General Assembly
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91_HB3398

 
                                               LRB9110559DJcd

 1        AN  ACT to amend the Illinois Public Aid Code by changing
 2    Section 5-5.4.

 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,   2000,   unless
28    specifically provided for in this Section.
29        For  facilities  licensed  by  the  Department  of Public
30    Health under the Nursing Home Care Act as  Intermediate  Care
31    for the Developmentally Disabled facilities or Long Term Care
 
                            -2-                LRB9110559DJcd
 1    for  Under Age 22 facilities, the rates taking effect on July
 2    1, 1998 shall include an  increase  of  3%.   For  facilities
 3    licensed by the Department of Public Health under the Nursing
 4    Home  Care  Act as Skilled Nursing facilities or Intermediate
 5    Care facilities, the rates taking  effect  on  July  1,  1998
 6    shall  include an increase of 3% plus $1.10 per resident-day,
 7    as defined by the Department.
 8        For facilities  licensed  by  the  Department  of  Public
 9    Health  under  the Nursing Home Care Act as Intermediate Care
10    for the Developmentally Disabled facilities or Long Term Care
11    for Under Age 22 facilities, the rates taking effect on  July
12    1,  1999  shall  include  an  increase of 1.6% plus $3.00 per
13    resident-day, as defined by the Department.   For  facilities
14    licensed by the Department of Public Health under the Nursing
15    Home  Care  Act as Skilled Nursing facilities or Intermediate
16    Care facilities, the rates taking  effect  on  July  1,  1999
17    shall  include an increase of 1.6% and, for services provided
18    on or after October 1, 1999, shall be increased by $4.00  per
19    resident-day, as defined by the Department.
20        Rates  established  effective  each  July  1 shall govern
21    payment for services rendered throughout  that  fiscal  year,
22    except  that  rates  established  on  July  1,  1996 shall be
23    increased by 6.8% for services provided on or  after  January
24    1,  1997.  Such rates will be based upon the rates calculated
25    for the year beginning July 1, 1990, and for subsequent years
26    thereafter shall be based on the facility  cost  reports  for
27    the  facility  fiscal year ending at any point in time during
28    the previous calendar year, updated to the  midpoint  of  the
29    rate  year.   The  cost  report  shall  be  on  file with the
30    Department no later than April 1 of the  current  rate  year.
31    Should  the  cost  report  not  be  on  file  by April 1, the
32    Department shall base the rate  on  the  latest  cost  report
33    filed  by  each  skilled  care facility and intermediate care
34    facility, updated to the midpoint of the current  rate  year.
 
                            -3-                LRB9110559DJcd
 1    In  determining rates for services rendered on and after July
 2    1, 1985, fixed time shall not be computed at less than  zero.
 3    The  Department shall not make any alterations of regulations
 4    which would reduce any component of the Medicaid  rate  to  a
 5    level  below what that component would have been utilizing in
 6    the rate effective on July 1, 1984.
 7        (2)  Shall take into account the actual costs incurred by
 8    facilities in providing services for  recipients  of  skilled
 9    nursing  and  intermediate  care  services  under the medical
10    assistance program.
11        (3)  Shall   take   into   account   the   medical    and
12    psycho-social characteristics and needs of the patients.
13        (4)  Shall take into account the actual costs incurred by
14    facilities  in  meeting licensing and certification standards
15    imposed and prescribed by the State of Illinois, any  of  its
16    political  subdivisions  or  municipalities and by the United
17    States Department of Health, Education and  Welfare  pursuant
18    to Title XIX of the Social Security Act.
19        (5)  Shall  include a quality incentive of at least $0.50
20    per resident per day for those facilities using a  nationally
21    recognized quality improvement program.
22        The  Department  of  Public  Aid  shall  develop  precise
23    standards  for  payments  to reimburse nursing facilities for
24    any utilization of appropriate rehabilitative  personnel  for
25    the  provision of rehabilitative services which is authorized
26    by federal regulations, including reimbursement for  services
27    provided by qualified therapists or qualified assistants, and
28    which  is in accordance with accepted professional practices.
29    Reimbursement also may  be  made  for  utilization  of  other
30    supportive personnel under appropriate supervision.
31    (Source:  P.A. 90-9, eff. 7-1-97; 90-588, eff. 7-1-98; 91-24,
32    eff. 7-1-99.)

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