93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004
HB4332


 
Introduced 02/02/04, by Jay C. Hoffman
 
SYNOPSIS AS INTRODUCED:
 		












305 ILCS 5/5-5.5
  from Ch. 23, par. 5-5.5









    Amends the Illinois Public Aid Code. In provisions concerning elements of the Medicaid payment rate for nursing homes, provides that
a nursing
home may at any time submit information to the Department of Public Aid to
supplement
the facility's most recent cost report to
document its increased allowable costs of providing services
resulting
from capital improvements made by the facility that have not been considered in
the
payment rates in effect for that facility for the current fiscal year. Requires
prompt verification by
the
Department and prompt adjustment of the facility's payment rates.
Makes implementation subject to appropriations.
Effective immediately.


















LRB093 19613 DRJ 45354 b




















FISCAL NOTE ACT MAY APPLY
















 


 


A BILL FOR









 














HB4332

LRB093 19613 DRJ 45354 b









1
    AN ACT in relation to public aid. 

 
2
    Be it enacted by the People of the State of Illinois, 
3
represented in the General Assembly: 


 
4
    Section 5. The Illinois Public Aid Code is amended by 
5
changing Section 5-5.5
as
follows:


 
6
    (305 ILCS 5/5-5.5)  (from Ch. 23, par. 5-5.5)
7
    Sec. 5-5.5. Elements of Payment Rate.


8
    (a) The Department of Public Aid shall develop a 
9
prospective method for
determining payment rates for skilled 
10
nursing and intermediate care
services in nursing facilities 
11
composed of the following cost elements:


12
        (1) Standard Services, with the cost of this component 
13
    being determined
by taking into account the actual costs to 
14
    the facilities of these services
subject to cost ceilings 
15
    to be defined in the Department's rules.


16
        (2) Resident Services, with the cost of this component 
17
    being
determined by taking into account the actual costs, 
18
    needs and utilization
of these services, as derived from an 
19
    assessment of the resident needs in
the nursing facilities.  
20
    The Department shall adopt rules governing
reimbursement 
21
    for resident services as listed in Section 5-1.1. Surveys 
22
    or
assessments of resident needs under this Section shall 
23
    include a review by
the facility of the results of such 
24
    assessments and a discussion of issues
in dispute with 
25
    authorized survey staff, unless the facility elects not to

26
    participate in such a review process.  Surveys or 
27
    assessments of resident
needs under this Section may be 
28
    conducted semi-annually and payment rates
relating to 
29
    resident services may be changed on a semi-annual basis.  
30
    The
Illinois Department shall initiate a project, either on 
31
    a pilot basis or
Statewide, to reimburse the cost of 
32
    resident services based on a
methodology which utilizes an 
 


 









HB4332
- 2 -
LRB093 19613 DRJ 45354 b







1
    assessment of resident needs to determine the
level of 
2
    reimbursement. This methodology shall be different from 
3
    the
payment criteria for resident services utilized by the 
4
    Illinois Department
on July 1, 1981.  On March 1, 1982, and 
5
    each year thereafter, until such
time when the Illinois 
6
    Department adopts the methodology used in such
project for 
7
    use statewide,
the Illinois Department shall report to the 
8
    General Assembly on the
implementation and progress of such 
9
    project. The report shall include:


10
            (A) A statement of the Illinois Department's goals 
11
        and objectives
for such project;


12
            (B) A description of such project, including the 
13
        number and type of
nursing facilities involved in the 
14
        project;


15
            (C) A description of the methodology used in such 
16
        project;


17
            (D) A description of the Illinois Department's 
18
        application of the
methodology;


19
            (E) A statement on the methodology's effect on the 
20
        quality of care
given to residents in the sample 
21
        nursing facilities; and


22
            (F) A statement on the cost of the methodology used 
23
        in such project
and a comparison of this cost with the 
24
        cost of the current payment criteria.


25
        (3) Ancillary Services, with the payment rate being 
26
    developed for
each individual type of service.  Payment 
27
    shall be made only when
authorized under procedures 
28
    developed by the Department of Public Aid.


29
        (4) Nurse's Aide Training, with the cost of this 
30
    component being
determined by taking into account the 
31
    actual cost to the facilities of
such training.


32
        (5) Real Estate Taxes, with the cost of this component 
33
    being
determined by taking into account the figures 
34
    contained in the most
currently available cost reports 
35
    (with no imposition of maximums) updated
to the midpoint of 
36
    the current rate year for long term care services
rendered 
 


 









HB4332
- 3 -
LRB093 19613 DRJ 45354 b







1
    between July 1, 1984 and June 30, 1985, and with the cost 
2
    of this
component being determined by taking into account 
3
    the actual 1983 taxes for
which the nursing homes were 
4
    assessed (with no imposition of maximums)
updated to the 
5
    midpoint of the current rate year for long term care

6
    services rendered between July 1, 1985 and June 30, 1986.


7
    (b) In developing a prospective method for determining 
8
payment rates
for skilled nursing and intermediate care 
9
services in nursing facilities,
the Department of Public Aid 
10
shall consider the following cost elements:


11
        (1) Reasonable capital cost determined by utilizing 
12
    incurred interest
rate and the current value of the 
13
    investment, including land, utilizing
composite rates, or 
14
    by utilizing such other reasonable cost related methods

15
    determined by the Department. However, beginning with the 
16
    rate
reimbursement period effective July 1, 1987, the 
17
    Department shall be
prohibited from establishing, 
18
    including, and implementing any depreciation
factor in 
19
    calculating the capital cost element.


20
        (2) Profit, with the actual amount being produced and 
21
    accruing to
the providers in the form of a return on their 
22
    total investment, on the
basis of their ability to 
23
    economically and efficiently deliver a type
of service.  The 
24
    method of payment may assure the opportunity for a
profit, 
25
    but shall not guarantee or establish a specific amount as a 
26
    cost.


27
    (b-5) A facility may at any time submit information to the 
28
Department of
Public
Aid to supplement the facility's most 
29
recent cost report to
document its increased allowable costs of

30
providing
services resulting from capital improvements made by 
31
the facility that have not
been considered in the payment rates 
32
in effect for that facility for the
current fiscal year. The

33
Department must
verify this supplemental information promptly 
34
after receiving it from the
facility. The
Department must 
35
adjust the facility's payment rates promptly after verifying

36
the facility's
increased allowable capital costs of providing 
 


 









HB4332
- 4 -
LRB093 19613 DRJ 45354 b







1
services.
Implementation of this subsection is subject to 
2
appropriations to the
Department for that purpose.

3
    (c) The Illinois Department may implement the amendatory 
4
changes to
this Section made by this amendatory Act of 1991 
5
through the use of
emergency rules in accordance with the 
6
provisions of Section 5.02 of the
Illinois Administrative 
7
Procedure Act. For purposes of the Illinois
Administrative 
8
Procedure Act, the adoption of rules to implement the

9
amendatory changes to this Section made by this amendatory
Act 
10
of 1991 shall be deemed an emergency and necessary for the 
11
public
interest, safety and welfare.


12
    (d) No later than January 1, 2001, the Department of Public 
13
Aid shall file
with the Joint Committee on Administrative 
14
Rules, pursuant to the Illinois
Administrative Procedure
Act,
a 
15
proposed rule, or a proposed amendment to an existing rule, 
16
regarding payment
for appropriate services, including 
17
assessment, care planning, discharge
planning, and treatment

18
provided by nursing facilities to residents who have a serious 
19
mental
illness.


20
(Source: P.A. 93-632, eff. 2-1-04.)


 
21
    Section 99. Effective date. This Act takes effect upon 
22
becoming law.