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1 | AN ACT in relation to public aid.
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2 | Be it enacted by the People of the State of Illinois, | ||||||
3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Section 5-5.4 as follows: | ||||||
6 | (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
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7 | Sec. 5-5.4. Standards of Payment - Department of Public | ||||||
8 | Aid.
The Department of Public Aid shall develop standards of | ||||||
9 | payment of skilled
nursing and intermediate care services in | ||||||
10 | facilities providing such services
under this Article which:
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11 | (1) Provide for the determination of a facility's payment
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12 | for skilled nursing and intermediate care services on a | ||||||
13 | prospective basis.
The amount of the payment rate for all | ||||||
14 | nursing facilities certified by the
Department of Public Health | ||||||
15 | under the Nursing Home Care Act as Intermediate
Care for the | ||||||
16 | Developmentally Disabled facilities, Long Term Care for Under | ||||||
17 | Age
22 facilities, Skilled Nursing facilities, or Intermediate | ||||||
18 | Care facilities
under the
medical assistance program shall be | ||||||
19 | prospectively established annually on the
basis of historical, | ||||||
20 | financial, and statistical data reflecting actual costs
from | ||||||
21 | prior years, which shall be applied to the current rate year | ||||||
22 | and updated
for inflation, except that the capital cost element | ||||||
23 | for newly constructed
facilities shall be based upon projected | ||||||
24 | budgets. The annually established
payment rate shall take | ||||||
25 | effect on July 1 in 1984 and subsequent years. No rate
increase | ||||||
26 | and no
update for inflation shall be provided on or after July | ||||||
27 | 1, 1994 and before
July 1, 2004, unless specifically provided | ||||||
28 | for in this
Section.
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29 | For facilities licensed by the Department of Public Health | ||||||
30 | under the Nursing
Home Care Act as Intermediate Care for the | ||||||
31 | Developmentally Disabled facilities
or Long Term Care for Under | ||||||
32 | Age 22 facilities, the rates taking effect on July
1, 1998 |
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1 | shall include an increase of 3%. For facilities licensed by the
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2 | Department of Public Health under the Nursing Home Care Act as | ||||||
3 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
4 | the rates taking effect on July 1,
1998 shall include an | ||||||
5 | increase of 3% plus $1.10 per resident-day, as defined by
the | ||||||
6 | Department.
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7 | For facilities licensed by the Department of Public Health | ||||||
8 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
9 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
10 | Age 22 facilities, the rates taking
effect on July 1, 1999 | ||||||
11 | shall include an increase of 1.6% plus $3.00 per
resident-day, | ||||||
12 | as defined by the Department. For facilities licensed by the
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13 | Department of Public Health under the Nursing Home Care Act as | ||||||
14 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
15 | the rates taking effect on July 1,
1999 shall include an | ||||||
16 | increase of 1.6% and, for services provided on or after
October | ||||||
17 | 1, 1999, shall be increased by $4.00 per resident-day, as | ||||||
18 | defined by
the Department.
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19 | For facilities licensed by the Department of Public Health | ||||||
20 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
21 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
22 | Age 22 facilities, the rates taking
effect on July 1, 2000 | ||||||
23 | shall include an increase of 2.5% per resident-day,
as defined | ||||||
24 | by the Department. For facilities licensed by the Department of
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25 | Public Health under the Nursing Home Care Act as Skilled | ||||||
26 | Nursing facilities or
Intermediate Care facilities, the rates | ||||||
27 | taking effect on July 1, 2000 shall
include an increase of 2.5% | ||||||
28 | per resident-day, as defined by the Department.
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29 | For facilities licensed by the Department of Public Health | ||||||
30 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
31 | or intermediate care
facilities, a new payment methodology must | ||||||
32 | be implemented for the nursing
component of the rate effective | ||||||
33 | July 1, 2003. The Department of Public Aid
shall develop the | ||||||
34 | new payment methodology using the Minimum Data Set
(MDS) as the | ||||||
35 | instrument to collect information concerning nursing home
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36 | resident condition necessary to compute the rate. The |
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1 | Department of Public Aid
shall develop the new payment | ||||||
2 | methodology to meet the unique needs of
Illinois nursing home | ||||||
3 | residents while remaining subject to the appropriations
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4 | provided by the General Assembly.
A transition period from the | ||||||
5 | payment methodology in effect on June 30, 2003
to the payment | ||||||
6 | methodology in effect on July 1, 2003 shall be provided for a
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7 | period not exceeding 2 years after implementation of the new | ||||||
8 | payment
methodology as follows:
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9 | (A) For a facility that would receive a lower
nursing | ||||||
10 | component rate per patient day under the new system than | ||||||
11 | the facility
received
effective on the date immediately | ||||||
12 | preceding the date that the Department
implements the new | ||||||
13 | payment methodology, the nursing component rate per | ||||||
14 | patient
day for the facility
shall be held at
the level in | ||||||
15 | effect on the date immediately preceding the date that the
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16 | Department implements the new payment methodology until a | ||||||
17 | higher nursing
component rate of
reimbursement is achieved | ||||||
18 | by that
facility.
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19 | (B) For a facility that would receive a higher nursing | ||||||
20 | component rate per
patient day under the payment | ||||||
21 | methodology in effect on July 1, 2003 than the
facility | ||||||
22 | received effective on the date immediately preceding the | ||||||
23 | date that the
Department implements the new payment | ||||||
24 | methodology, the nursing component rate
per patient day for | ||||||
25 | the facility shall be adjusted.
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26 | (C) Notwithstanding paragraphs (A) and (B), the | ||||||
27 | nursing component rate per
patient day for the facility | ||||||
28 | shall be adjusted subject to appropriations
provided by the | ||||||
29 | General Assembly.
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30 | For facilities licensed by the Department of Public Health | ||||||
31 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
32 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
33 | Age 22 facilities, the rates taking
effect on March 1, 2001 | ||||||
34 | shall include a statewide increase of 7.85%, as
defined by the | ||||||
35 | Department.
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36 | For facilities licensed by the Department of Public Health |
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1 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
2 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
3 | Age 22 facilities, the rates taking
effect on April 1, 2002 | ||||||
4 | shall include a statewide increase of 2.0%, as
defined by the | ||||||
5 | Department.
This increase terminates on July 1, 2002;
beginning | ||||||
6 | July 1, 2002 these rates are reduced to the level of the rates
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7 | in effect on March 31, 2002, as defined by the Department.
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8 | For facilities licensed by the Department of Public Health | ||||||
9 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
10 | or intermediate care
facilities, the rates taking effect on | ||||||
11 | July 1, 2001 shall be computed using the most recent cost | ||||||
12 | reports
on file with the Department of Public Aid no later than | ||||||
13 | April 1, 2000,
updated for inflation to January 1, 2001. For | ||||||
14 | rates effective July 1, 2001
only, rates shall be the greater | ||||||
15 | of the rate computed for July 1, 2001
or the rate effective on | ||||||
16 | June 30, 2001.
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17 | Notwithstanding any other provision of this Section, for | ||||||
18 | facilities
licensed by the Department of Public Health under | ||||||
19 | the Nursing Home Care Act
as skilled nursing facilities or | ||||||
20 | intermediate care facilities, the Illinois
Department shall | ||||||
21 | determine by rule the rates taking effect on July 1, 2002,
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22 | which shall be 5.9% less than the rates in effect on June 30, | ||||||
23 | 2002.
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24 | Notwithstanding any other provision of this Section, for | ||||||
25 | facilities
licensed by the Department of Public Health under | ||||||
26 | the Nursing Home Care Act as
skilled nursing
facilities or | ||||||
27 | intermediate care facilities, the Illinois Department shall
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28 | determine by rule the rates taking effect on July 1, 2003, | ||||||
29 | which shall be 3.0%
less than the rates in effect on June 30, | ||||||
30 | 2002. This rate shall take
effect only upon approval and
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31 | implementation of the payment methodologies required under | ||||||
32 | Section 5A-12.
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33 | For facilities
licensed
by the
Department of Public Health | ||||||
34 | under the Nursing Home Care Act as Intermediate
Care for
the | ||||||
35 | Developmentally Disabled facilities or as long-term care | ||||||
36 | facilities for
residents under 22 years of age, the rates |
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1 | taking effect on July 1,
2003 shall
include a statewide | ||||||
2 | increase of 4%, as defined by the Department.
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3 | Notwithstanding any other provision of this Section, for | ||||||
4 | facilities licensed by the Department of Public Health under | ||||||
5 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
6 | intermediate care facilities, effective July 1, 2004, facility | ||||||
7 | rates shall be increased by the difference between (i) a | ||||||
8 | facility's per diem property, liability, and malpractice | ||||||
9 | insurance costs as reported in the cost report filed with the | ||||||
10 | Department of Public Aid and used to establish rates effective | ||||||
11 | July 1, 2001 and (ii) those same costs as reported in the | ||||||
12 | facility's 2002 cost report. These costs shall be passed | ||||||
13 | through to the facility without caps or limitations, except for | ||||||
14 | adjustments required under normal auditing procedures.
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15 | Rates established effective each July 1 shall govern | ||||||
16 | payment
for services rendered throughout that fiscal year, | ||||||
17 | except that rates
established on July 1, 1996 shall be | ||||||
18 | increased by 6.8% for services
provided on or after January 1, | ||||||
19 | 1997. Such rates will be based
upon the rates calculated for | ||||||
20 | the year beginning July 1, 1990, and for
subsequent years | ||||||
21 | thereafter until June 30, 2001 shall be based on the
facility | ||||||
22 | cost reports
for the facility fiscal year ending at any point | ||||||
23 | in time during the previous
calendar year, updated to the | ||||||
24 | midpoint of the rate year. The cost report
shall be on file | ||||||
25 | with the Department no later than April 1 of the current
rate | ||||||
26 | year. Should the cost report not be on file by April 1, the | ||||||
27 | Department
shall base the rate on the latest cost report filed | ||||||
28 | by each skilled care
facility and intermediate care facility, | ||||||
29 | updated to the midpoint of the
current rate year. In | ||||||
30 | determining rates for services rendered on and after
July 1, | ||||||
31 | 1985, fixed time shall not be computed at less than zero. The
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32 | Department shall not make any alterations of regulations which | ||||||
33 | would reduce
any component of the Medicaid rate to a level | ||||||
34 | below what that component would
have been utilizing in the rate | ||||||
35 | effective on July 1, 1984.
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36 | (2) Shall take into account the actual costs incurred by |
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1 | facilities
in providing services for recipients of skilled | ||||||
2 | nursing and intermediate
care services under the medical | ||||||
3 | assistance program.
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4 | (3) Shall take into account the medical and psycho-social
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5 | characteristics and needs of the patients.
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6 | (4) Shall take into account the actual costs incurred by | ||||||
7 | facilities in
meeting licensing and certification standards | ||||||
8 | imposed and prescribed by the
State of Illinois, any of its | ||||||
9 | political subdivisions or municipalities and by
the U.S. | ||||||
10 | Department of Health and Human Services pursuant to Title XIX | ||||||
11 | of the
Social Security Act.
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12 | The Department of Public Aid shall develop precise | ||||||
13 | standards for
payments to reimburse nursing facilities for any | ||||||
14 | utilization of
appropriate rehabilitative personnel for the | ||||||
15 | provision of rehabilitative
services which is authorized by | ||||||
16 | federal regulations, including
reimbursement for services | ||||||
17 | provided by qualified therapists or qualified
assistants, and | ||||||
18 | which is in accordance with accepted professional
practices. | ||||||
19 | Reimbursement also may be made for utilization of other
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20 | supportive personnel under appropriate supervision.
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21 | (Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597, | ||||||
22 | eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20, | ||||||
23 | eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, eff. 2-3-04; revised | ||||||
24 | 2-3-04.)
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25 | Section 99. Effective date. This Act takes effect July 1, | ||||||
26 | 2004.
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