101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3037

 

Introduced , by Rep. Michael D. Unes

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.2  from Ch. 23, par. 5-5.2

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to make all room and board payments directly to long-term care providers and all hospice care payments directly to hospice care providers whenever recipients of medical assistance opt to receive hospice care at long-term care facilities.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

HB3037LRB101 09789 KTG 54890 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. Notwithstanding any
14other provision of law, whenever a recipient of medical
15assistance opts to receive hospice care at a long-term care
16facility, the Department shall make all room and board payments
17directly to the long-term care provider and all hospice care
18payments directly to the hospice care provider.
19    (c) Notwithstanding any other provisions of this Code, the
20methodologies for reimbursement of nursing services as
21provided under this Article shall no longer be applicable for
22bills payable for nursing services rendered on or after a new
23reimbursement system based on the Resource Utilization Groups

 

 

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1(RUGs) has been fully operationalized, which shall take effect
2for services provided on or after January 1, 2014.
3    (d) The new nursing services reimbursement methodology
4utilizing RUG-IV 48 grouper model, which shall be referred to
5as the RUGs reimbursement system, taking effect January 1,
62014, shall be based on the following:
7        (1) The methodology shall be resident-driven,
8    facility-specific, and cost-based.
9        (2) Costs shall be annually rebased and case mix index
10    quarterly updated. The nursing services methodology will
11    be assigned to the Medicaid enrolled residents on record as
12    of 30 days prior to the beginning of the rate period in the
13    Department's Medicaid Management Information System (MMIS)
14    as present on the last day of the second quarter preceding
15    the rate period based upon the Assessment Reference Date of
16    the Minimum Data Set (MDS).
17        (3) Regional wage adjustors based on the Health Service
18    Areas (HSA) groupings and adjusters in effect on April 30,
19    2012 shall be included.
20        (4) Case mix index shall be assigned to each resident
21    class based on the Centers for Medicare and Medicaid
22    Services staff time measurement study in effect on July 1,
23    2013, utilizing an index maximization approach.
24        (5) The pool of funds available for distribution by
25    case mix and the base facility rate shall be determined
26    using the formula contained in subsection (d-1).

 

 

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1    (d-1) Calculation of base year Statewide RUG-IV nursing
2base per diem rate.
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
24funding in the amount up to $10,000,000 for per diem add-ons to
25the RUGS methodology for dates of service on and after July 1,
262014:

 

 

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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, the
8RUG-IV nursing component per diem for a nursing home shall be
9the product of the statewide RUG-IV nursing base per diem rate,
10the facility average case mix index, and the regional wage
11adjustor. Transition rates for services provided between
12January 1, 2014 and December 31, 2014 shall be as follows:
13        (1) The transition RUG-IV per diem nursing rate for
14    nursing homes whose rate calculated in this subsection
15    (e-2) is greater than the nursing component rate in effect
16    July 1, 2012 shall be paid the sum of:
17            (A) The nursing component rate in effect July 1,
18        2012; plus
19            (B) The difference of the RUG-IV nursing component
20        per diem calculated for the current quarter minus the
21        nursing component rate in effect July 1, 2012
22        multiplied by 0.88.
23        (2) The transition RUG-IV per diem nursing rate for
24    nursing homes whose rate calculated in this subsection
25    (e-2) is less than the nursing component rate in effect
26    July 1, 2012 shall be paid the sum of:

 

 

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1            (A) The nursing component rate in effect July 1,
2        2012; plus
3            (B) The difference of the RUG-IV nursing component
4        per diem calculated for the current quarter minus the
5        nursing component rate in effect July 1, 2012
6        multiplied by 0.13.
7    (f) Notwithstanding any other provision of this Code, on
8and after July 1, 2012, reimbursement rates associated with the
9nursing or support components of the current nursing facility
10rate methodology shall not increase beyond the level effective
11May 1, 2011 until a new reimbursement system based on the RUGs
12IV 48 grouper model has been fully operationalized.
13    (g) Notwithstanding any other provision of this Code, on
14and after July 1, 2012, for facilities not designated by the
15Department of Healthcare and Family Services as "Institutions
16for Mental Disease", rates effective May 1, 2011 shall be
17adjusted as follows:
18        (1) Individual nursing rates for residents classified
19    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
20    ending March 31, 2012 shall be reduced by 10%;
21        (2) Individual nursing rates for residents classified
22    in all other RUG IV groups shall be reduced by 1.0%;
23        (3) Facility rates for the capital and support
24    components shall be reduced by 1.7%.
25    (h) Notwithstanding any other provision of this Code, on
26and after July 1, 2012, nursing facilities designated by the

 

 

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1Department of Healthcare and Family Services as "Institutions
2for Mental Disease" and "Institutions for Mental Disease" that
3are facilities licensed under the Specialized Mental Health
4Rehabilitation Act of 2013 shall have the nursing,
5socio-developmental, capital, and support components of their
6reimbursement rate effective May 1, 2011 reduced in total by
72.7%.
8    (i) On and after July 1, 2014, the reimbursement rates for
9the support component of the nursing facility rate for
10facilities licensed under the Nursing Home Care Act as skilled
11or intermediate care facilities shall be the rate in effect on
12June 30, 2014 increased by 8.17%.
13(Source: P.A. 98-104, Article 6, Section 6-240, eff. 7-22-13;
1498-104, Article 11, Section 11-35, eff. 7-22-13; 98-651, eff.
156-16-14; 98-727, eff. 7-16-14; 98-756, eff. 7-16-14; 99-78,
16eff. 7-20-15.)