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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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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 | The payment methodology established under this Section shall | ||||||
31 | include, but is not limited to, specific adjustments for | ||||||
32 | additional care and services required by persons with | ||||||
33 | Alzheimer's Disease and related conditions.
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34 | For facilities licensed by the Department of Public Health | ||||||
35 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
36 | Developmentally Disabled
facilities or Long Term Care for Under |
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1 | Age 22 facilities, the rates taking
effect on March 1, 2001 | ||||||
2 | shall include a statewide increase of 7.85%, as
defined by the | ||||||
3 | Department.
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4 | For facilities licensed by the Department of Public Health | ||||||
5 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
6 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
7 | Age 22 facilities, the rates taking
effect on April 1, 2002 | ||||||
8 | shall include a statewide increase of 2.0%, as
defined by the | ||||||
9 | Department.
This increase terminates on July 1, 2002;
beginning | ||||||
10 | July 1, 2002 these rates are reduced to the level of the rates
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11 | in effect on March 31, 2002, as defined by the Department.
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12 | For facilities licensed by the Department of Public Health | ||||||
13 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
14 | or intermediate care
facilities, the rates taking effect on | ||||||
15 | July 1, 2001 shall be computed using the most recent cost | ||||||
16 | reports
on file with the Department of Public Aid no later than | ||||||
17 | April 1, 2000,
updated for inflation to January 1, 2001. For | ||||||
18 | rates effective July 1, 2001
only, rates shall be the greater | ||||||
19 | of the rate computed for July 1, 2001
or the rate effective on | ||||||
20 | June 30, 2001.
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21 | Notwithstanding any other provision of this Section, for | ||||||
22 | facilities
licensed by the Department of Public Health under | ||||||
23 | the Nursing Home Care Act
as skilled nursing facilities or | ||||||
24 | intermediate care facilities, the Illinois
Department shall | ||||||
25 | determine by rule the rates taking effect on July 1, 2002,
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26 | which shall be 5.9% less than the rates in effect on June 30, | ||||||
27 | 2002.
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28 | For facilities
licensed
by the
Department of Public Health | ||||||
29 | under the Nursing Home Care Act as Intermediate
Care for
the | ||||||
30 | Developmentally Disabled facilities or as long-term care | ||||||
31 | facilities for
residents under 22 years of age, the rates | ||||||
32 | taking effect on July 1,
2003 shall
include a statewide | ||||||
33 | increase of 4%, as defined by the Department.
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34 | Rates established effective each July 1 shall govern | ||||||
35 | payment
for services rendered throughout that fiscal year, | ||||||
36 | except that rates
established on July 1, 1996 shall be |
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1 | increased by 6.8% for services
provided on or after January 1, | ||||||
2 | 1997. Such rates will be based
upon the rates calculated for | ||||||
3 | the year beginning July 1, 1990, and for
subsequent years | ||||||
4 | thereafter until June 30, 2001 shall be based on the
facility | ||||||
5 | cost reports
for the facility fiscal year ending at any point | ||||||
6 | in time during the previous
calendar year, updated to the | ||||||
7 | midpoint of the rate year. The cost report
shall be on file | ||||||
8 | with the Department no later than April 1 of the current
rate | ||||||
9 | year. Should the cost report not be on file by April 1, the | ||||||
10 | Department
shall base the rate on the latest cost report filed | ||||||
11 | by each skilled care
facility and intermediate care facility, | ||||||
12 | updated to the midpoint of the
current rate year. In | ||||||
13 | determining rates for services rendered on and after
July 1, | ||||||
14 | 1985, fixed time shall not be computed at less than zero. The
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15 | Department shall not make any alterations of regulations which | ||||||
16 | would reduce
any component of the Medicaid rate to a level | ||||||
17 | below what that component would
have been utilizing in the rate | ||||||
18 | effective on July 1, 1984.
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19 | (2) Shall take into account the actual costs incurred by | ||||||
20 | facilities
in providing services for recipients of skilled | ||||||
21 | nursing and intermediate
care services under the medical | ||||||
22 | assistance program.
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23 | (3) Shall take into account the medical and psycho-social
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24 | characteristics and needs of the patients.
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25 | (4) Shall take into account the actual costs incurred by | ||||||
26 | facilities in
meeting licensing and certification standards | ||||||
27 | imposed and prescribed by the
State of Illinois, any of its | ||||||
28 | political subdivisions or municipalities and by
the U.S. | ||||||
29 | Department of Health and Human Services pursuant to Title XIX | ||||||
30 | of the
Social Security Act.
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31 | The Department of Public Aid shall develop precise | ||||||
32 | standards for
payments to reimburse nursing facilities for any | ||||||
33 | utilization of
appropriate rehabilitative personnel for the | ||||||
34 | provision of rehabilitative
services which is authorized by | ||||||
35 | federal regulations, including
reimbursement for services | ||||||
36 | provided by qualified therapists or qualified
assistants, and |
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1 | which is in accordance with accepted professional
practices. | ||||||
2 | Reimbursement also may be made for utilization of other
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3 | supportive personnel under appropriate supervision.
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4 | (Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597, | ||||||
5 | eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20, | ||||||
6 | eff. 6-20-03; 93-649, eff. 1-8-04.)
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