Sen. Ira I. Silverstein
Filed: 5/18/2004
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1 | AMENDMENT TO HOUSE BILL 2220
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2 | AMENDMENT NO. ______. Amend House Bill 2220 by replacing | ||||||
3 | everything after the enacting clause with the following:
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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 |
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1 | effect on July 1 in 1984 and subsequent years. No rate
increase | ||||||
2 | and no
update for inflation shall be provided on or after July | ||||||
3 | 1, 1994 and before
July 1, 2004, unless specifically provided | ||||||
4 | for in this
Section.
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5 | For facilities licensed by the Department of Public Health | ||||||
6 | under the Nursing
Home Care Act as Intermediate Care for the | ||||||
7 | Developmentally Disabled facilities
or Long Term Care for Under | ||||||
8 | Age 22 facilities, the rates taking effect on July
1, 1998 | ||||||
9 | shall include an increase of 3%. For facilities licensed by the
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10 | Department of Public Health under the Nursing Home Care Act as | ||||||
11 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
12 | the rates taking effect on July 1,
1998 shall include an | ||||||
13 | increase of 3% plus $1.10 per resident-day, as defined by
the | ||||||
14 | Department.
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15 | For facilities licensed by the Department of Public Health | ||||||
16 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
17 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
18 | Age 22 facilities, the rates taking
effect on July 1, 1999 | ||||||
19 | shall include an increase of 1.6% plus $3.00 per
resident-day, | ||||||
20 | as defined by the Department. For facilities licensed by the
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21 | Department of Public Health under the Nursing Home Care Act as | ||||||
22 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
23 | the rates taking effect on July 1,
1999 shall include an | ||||||
24 | increase of 1.6% and, for services provided on or after
October | ||||||
25 | 1, 1999, shall be increased by $4.00 per resident-day, as | ||||||
26 | defined by
the Department.
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27 | For facilities licensed by the Department of Public Health | ||||||
28 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
29 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
30 | Age 22 facilities, the rates taking
effect on July 1, 2000 | ||||||
31 | shall include an increase of 2.5% per resident-day,
as defined | ||||||
32 | by the Department. For facilities licensed by the Department of
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33 | Public Health under the Nursing Home Care Act as Skilled | ||||||
34 | Nursing facilities or
Intermediate Care facilities, the rates |
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1 | taking effect on July 1, 2000 shall
include an increase of 2.5% | ||||||
2 | per resident-day, as defined by the Department.
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3 | For facilities licensed by the Department of Public Health | ||||||
4 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
5 | or intermediate care
facilities, a new payment methodology must | ||||||
6 | be implemented for the nursing
component of the rate effective | ||||||
7 | July 1, 2003. The Department of Public Aid
shall develop the | ||||||
8 | new payment methodology using the Minimum Data Set
(MDS) as the | ||||||
9 | instrument to collect information concerning nursing home
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10 | resident condition necessary to compute the rate. The | ||||||
11 | Department of Public Aid
shall develop the new payment | ||||||
12 | methodology to meet the unique needs of
Illinois nursing home | ||||||
13 | residents while remaining subject to the appropriations
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14 | provided by the General Assembly.
A transition period from the | ||||||
15 | payment methodology in effect on June 30, 2003
to the payment | ||||||
16 | methodology in effect on July 1, 2003 shall be provided for a
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17 | period not exceeding 2 years after implementation of the new | ||||||
18 | payment
methodology as follows:
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19 | (A) For a facility that would receive a lower
nursing | ||||||
20 | component rate per patient day under the new system than | ||||||
21 | the facility
received
effective on the date immediately | ||||||
22 | preceding the date that the Department
implements the new | ||||||
23 | payment methodology, the nursing component rate per | ||||||
24 | patient
day for the facility
shall be held at
the level in | ||||||
25 | effect on the date immediately preceding the date that the
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26 | Department implements the new payment methodology until a | ||||||
27 | higher nursing
component rate of
reimbursement is achieved | ||||||
28 | by that
facility.
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29 | (B) For a facility that would receive a higher nursing | ||||||
30 | component rate per
patient day under the payment | ||||||
31 | methodology in effect on July 1, 2003 than the
facility | ||||||
32 | received effective on the date immediately preceding the | ||||||
33 | date that the
Department implements the new payment | ||||||
34 | methodology, the nursing component rate
per patient day for |
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1 | the facility shall be adjusted.
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2 | (C) Notwithstanding paragraphs (A) and (B), the | ||||||
3 | nursing component rate per
patient day for the facility | ||||||
4 | shall be adjusted subject to appropriations
provided by the | ||||||
5 | General Assembly.
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6 | For facilities licensed by the Department of Public Health | ||||||
7 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
8 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
9 | Age 22 facilities, the rates taking
effect on March 1, 2001 | ||||||
10 | shall include a statewide increase of 7.85%, as
defined by the | ||||||
11 | Department.
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12 | For facilities licensed by the Department of Public Health | ||||||
13 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
14 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
15 | Age 22 facilities, the rates taking
effect on April 1, 2002 | ||||||
16 | shall include a statewide increase of 2.0%, as
defined by the | ||||||
17 | Department.
This increase terminates on July 1, 2002;
beginning | ||||||
18 | July 1, 2002 these rates are reduced to the level of the rates
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19 | in effect on March 31, 2002, as defined by the Department.
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20 | For facilities licensed by the Department of Public Health | ||||||
21 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
22 | or intermediate care
facilities, the rates taking effect on | ||||||
23 | July 1, 2001 shall be computed using the most recent cost | ||||||
24 | reports
on file with the Department of Public Aid no later than | ||||||
25 | April 1, 2000,
updated for inflation to January 1, 2001. For | ||||||
26 | rates effective July 1, 2001
only, rates shall be the greater | ||||||
27 | of the rate computed for July 1, 2001
or the rate effective on | ||||||
28 | June 30, 2001.
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29 | Notwithstanding any other provision of this Section, for | ||||||
30 | facilities
licensed by the Department of Public Health under | ||||||
31 | the Nursing Home Care Act
as skilled nursing facilities or | ||||||
32 | intermediate care facilities, the Illinois
Department shall | ||||||
33 | determine by rule the rates taking effect on July 1, 2002,
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34 | which shall be 5.9% less than the rates in effect on June 30, |
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1 | 2002.
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2 | Notwithstanding any other provision of this Section, for | ||||||
3 | facilities
licensed by the Department of Public Health under | ||||||
4 | the Nursing Home Care Act as
skilled nursing
facilities or | ||||||
5 | intermediate care facilities, the Illinois Department shall
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6 | determine by rule the rates taking effect on July 1, 2003, | ||||||
7 | which shall be 3.0%
less than the rates in effect on June 30, | ||||||
8 | 2002. This rate shall take
effect only upon approval and
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9 | implementation of the payment methodologies required under | ||||||
10 | Section 5A-12.
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11 | For facilities
licensed
by the
Department of Public Health | ||||||
12 | under the Nursing Home Care Act as Intermediate
Care for
the | ||||||
13 | Developmentally Disabled facilities or as long-term care | ||||||
14 | facilities for
residents under 22 years of age, the rates | ||||||
15 | taking effect on July 1,
2003 shall
include a statewide | ||||||
16 | increase of 4%, as defined by the Department.
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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, effective July 1, 2004, facility | ||||||
21 | rates shall be increased by the difference between (i) a | ||||||
22 | facility's per diem property, liability, and malpractice | ||||||
23 | insurance costs as reported in the cost report filed with the | ||||||
24 | Department of Public Aid and used to establish rates effective | ||||||
25 | July 1, 2001 and (ii) those same costs as reported in the | ||||||
26 | facility's 2002 cost report. These costs shall be passed | ||||||
27 | through to the facility without caps or limitations, except for | ||||||
28 | adjustments required under normal auditing procedures.
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29 | Rates established effective each July 1 shall govern | ||||||
30 | payment
for services rendered throughout that fiscal year, | ||||||
31 | except that rates
established on July 1, 1996 shall be | ||||||
32 | increased by 6.8% for services
provided on or after January 1, | ||||||
33 | 1997. Such rates will be based
upon the rates calculated for | ||||||
34 | the year beginning July 1, 1990, and for
subsequent years |
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1 | thereafter until June 30, 2001 shall be based on the
facility | ||||||
2 | cost reports
for the facility fiscal year ending at any point | ||||||
3 | in time during the previous
calendar year, updated to the | ||||||
4 | midpoint of the rate year. The cost report
shall be on file | ||||||
5 | with the Department no later than April 1 of the current
rate | ||||||
6 | year. Should the cost report not be on file by April 1, the | ||||||
7 | Department
shall base the rate on the latest cost report filed | ||||||
8 | by each skilled care
facility and intermediate care facility, | ||||||
9 | updated to the midpoint of the
current rate year. In | ||||||
10 | determining rates for services rendered on and after
July 1, | ||||||
11 | 1985, fixed time shall not be computed at less than zero. The
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12 | Department shall not make any alterations of regulations which | ||||||
13 | would reduce
any component of the Medicaid rate to a level | ||||||
14 | below what that component would
have been utilizing in the rate | ||||||
15 | effective on July 1, 1984.
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16 | (2) Shall take into account the actual costs incurred by | ||||||
17 | facilities
in providing services for recipients of skilled | ||||||
18 | nursing and intermediate
care services under the medical | ||||||
19 | assistance program.
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20 | (3) Shall take into account the medical and psycho-social
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21 | characteristics and needs of the patients.
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22 | (4) Shall take into account the actual costs incurred by | ||||||
23 | facilities in
meeting licensing and certification standards | ||||||
24 | imposed and prescribed by the
State of Illinois, any of its | ||||||
25 | political subdivisions or municipalities and by
the U.S. | ||||||
26 | Department of Health and Human Services pursuant to Title XIX | ||||||
27 | of the
Social Security Act.
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28 | The Department of Public Aid shall develop precise | ||||||
29 | standards for
payments to reimburse nursing facilities for any | ||||||
30 | utilization of
appropriate rehabilitative personnel for the | ||||||
31 | provision of rehabilitative
services which is authorized by | ||||||
32 | federal regulations, including
reimbursement for services | ||||||
33 | provided by qualified therapists or qualified
assistants, and | ||||||
34 | which is in accordance with accepted professional
practices. |
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1 | Reimbursement also may be made for utilization of other
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2 | supportive personnel under appropriate supervision.
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3 | (Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597, | ||||||
4 | eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20, | ||||||
5 | eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, eff. 2-3-04; revised | ||||||
6 | 2-3-04.)
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7 | Section 99. Effective date. This Act takes effect July 1, | ||||||
8 | 2004.".
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