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SB0063 Engrossed |
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LRB094 04047 DRJ 34066 b |
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Public Aid Code is amended by |
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| changing Section 5-5.4
as follows:
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| (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
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| Sec. 5-5.4. Standards of Payment - Department of Public |
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| Aid.
The Department of Public Aid shall develop standards of |
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| payment of skilled
nursing and intermediate care services in |
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| facilities providing such services
under this Article which:
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| (1) Provide for the determination of a facility's payment
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| for skilled nursing and intermediate care services on a |
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| prospective basis.
The amount of the payment rate for all |
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| nursing facilities certified by the
Department of Public Health |
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| under the Nursing Home Care Act as Intermediate
Care for the |
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| Developmentally Disabled facilities, Long Term Care for Under |
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| Age
22 facilities, Skilled Nursing facilities, or Intermediate |
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| Care facilities
under the
medical assistance program shall be |
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| prospectively established annually on the
basis of historical, |
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| financial, and statistical data reflecting actual costs
from |
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| prior years, which shall be applied to the current rate year |
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| and updated
for inflation, except that the capital cost element |
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| for newly constructed
facilities shall be based upon projected |
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| budgets. The annually established
payment rate shall take |
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| effect on July 1 in 1984 and subsequent years. No rate
increase |
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| and no
update for inflation shall be provided on or after July |
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| 1, 1994 and before
July 1, 2005, unless specifically provided |
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| for in this
Section.
The changes made by this amendatory Act of |
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| the 93rd General Assembly extending the duration of the |
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| prohibition against a rate increase or update for inflation are |
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| effective retroactive to July 1, 2004.
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| For facilities licensed by the Department of Public Health |
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SB0063 Engrossed |
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LRB094 04047 DRJ 34066 b |
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| under the Nursing
Home Care Act as Intermediate Care for the |
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| Developmentally Disabled facilities
or Long Term Care for Under |
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| Age 22 facilities, the rates taking effect on July
1, 1998 |
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| shall include an increase of 3%. For facilities licensed by the
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| Department of Public Health under the Nursing Home Care Act as |
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| Skilled Nursing
facilities or Intermediate Care facilities, |
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| the rates taking effect on July 1,
1998 shall include an |
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| increase of 3% plus $1.10 per resident-day, as defined by
the |
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| Department.
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| For facilities licensed by the Department of Public Health |
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| under the
Nursing Home Care Act as Intermediate Care for the |
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| Developmentally Disabled
facilities or Long Term Care for Under |
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| Age 22 facilities, the rates taking
effect on July 1, 1999 |
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| shall include an increase of 1.6% plus $3.00 per
resident-day, |
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| as defined by the Department. For facilities licensed by the
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| Department of Public Health under the Nursing Home Care Act as |
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| Skilled Nursing
facilities or Intermediate Care facilities, |
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| the rates taking effect on July 1,
1999 shall include an |
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| increase of 1.6% and, for services provided on or after
October |
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| 1, 1999, shall be increased by $4.00 per resident-day, as |
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| defined by
the Department.
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| For facilities licensed by the Department of Public Health |
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| under the
Nursing Home Care Act as Intermediate Care for the |
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| Developmentally Disabled
facilities or Long Term Care for Under |
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| Age 22 facilities, the rates taking
effect on July 1, 2000 |
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| shall include an increase of 2.5% per resident-day,
as defined |
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| by the Department. For facilities licensed by the Department of
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| Public Health under the Nursing Home Care Act as Skilled |
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| Nursing facilities or
Intermediate Care facilities, the rates |
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| taking effect on July 1, 2000 shall
include an increase of 2.5% |
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| per resident-day, as defined by the Department.
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| For facilities licensed by the Department of Public Health |
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| under the
Nursing Home Care Act as skilled nursing facilities |
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| or intermediate care
facilities, a new payment methodology must |
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| be implemented for the nursing
component of the rate effective |
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| July 1, 2003. The Department of Public Aid
shall develop the |
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LRB094 04047 DRJ 34066 b |
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| new payment methodology using the Minimum Data Set
(MDS) as the |
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| instrument to collect information concerning nursing home
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| resident condition necessary to compute the rate. The |
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| Department of Public Aid
shall develop the new payment |
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| methodology to meet the unique needs of
Illinois nursing home |
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| residents while remaining subject to the appropriations
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| provided by the General Assembly.
A transition period from the |
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| payment methodology in effect on June 30, 2003
to the payment |
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| methodology in effect on July 1, 2003 shall be provided for a
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| period not exceeding 3
2 years after implementation of the new |
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| payment
methodology as follows:
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| (A) For a facility that would receive a lower
nursing |
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| component rate per patient day under the new system than |
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| the facility
received
effective on the date immediately |
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| preceding the date that the Department
implements the new |
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| payment methodology, the nursing component rate per |
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| patient
day for the facility
shall be held at
the level in |
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| effect on the date immediately preceding the date that the
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| Department implements the new payment methodology until a |
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| higher nursing
component rate of
reimbursement is achieved |
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| by that
facility.
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| (B) For a facility that would receive a higher nursing |
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| component rate per
patient day under the payment |
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| methodology in effect on July 1, 2003 than the
facility |
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| received effective on the date immediately preceding the |
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| date that the
Department implements the new payment |
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| methodology, the nursing component rate
per patient day for |
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| the facility shall be adjusted.
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| (C) Notwithstanding paragraphs (A) and (B), the |
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| nursing component rate per
patient day for the facility |
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| shall be adjusted subject to appropriations
provided by the |
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| General Assembly.
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| For facilities licensed by the Department of Public Health |
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| under the
Nursing Home Care Act as Intermediate Care for the |
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| Developmentally Disabled
facilities or Long Term Care for Under |
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| Age 22 facilities, the rates taking
effect on March 1, 2001 |
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SB0063 Engrossed |
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LRB094 04047 DRJ 34066 b |
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| shall include a statewide increase of 7.85%, as
defined by the |
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| Department.
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| For facilities licensed by the Department of Public Health |
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| under the
Nursing Home Care Act as Intermediate Care for the |
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| Developmentally Disabled
facilities or Long Term Care for Under |
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| Age 22 facilities, the rates taking
effect on April 1, 2002 |
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| shall include a statewide increase of 2.0%, as
defined by the |
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| Department.
This increase terminates on July 1, 2002;
beginning |
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| July 1, 2002 these rates are reduced to the level of the rates
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| in effect on March 31, 2002, as defined by the Department.
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| For facilities licensed by the Department of Public Health |
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| under the
Nursing Home Care Act as skilled nursing facilities |
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| or intermediate care
facilities, the rates taking effect on |
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| July 1, 2001 shall be computed using the most recent cost |
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| reports
on file with the Department of Public Aid no later than |
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| April 1, 2000,
updated for inflation to January 1, 2001. For |
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| rates effective July 1, 2001
only, rates shall be the greater |
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| of the rate computed for July 1, 2001
or the rate effective on |
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| June 30, 2001.
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| Notwithstanding any other provision of this Section, for |
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| facilities
licensed by the Department of Public Health under |
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| the Nursing Home Care Act
as skilled nursing facilities or |
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| intermediate care facilities, the Illinois
Department shall |
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| determine by rule the rates taking effect on July 1, 2002,
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| which shall be 5.9% less than the rates in effect on June 30, |
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| 2002.
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| Notwithstanding any other provision of this Section, for |
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| facilities
licensed by the Department of Public Health under |
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| the Nursing Home Care Act as
skilled nursing
facilities or |
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| intermediate care facilities, if the payment methodologies |
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| required under Section 5A-12 and the waiver granted under 42 |
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| CFR 433.68 are approved by the United States Centers for |
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| Medicare and Medicaid Services, the rates taking effect on July |
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| 1, 2004 shall be 3.0% greater than the rates in effect on June |
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| 30, 2004. These rates shall take
effect only upon approval and
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| implementation of the payment methodologies required under |
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SB0063 Engrossed |
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LRB094 04047 DRJ 34066 b |
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| Section 5A-12.
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| Notwithstanding any other provisions of this Section, for |
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| facilities licensed by the Department of Public Health under |
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| the Nursing Home Care Act as skilled nursing facilities or |
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| intermediate care facilities, the rates taking effect on |
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| January 1, 2005 shall be 3% more than the rates in effect on |
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| December 31, 2004.
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| For facilities
licensed
by the
Department of Public Health |
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| under the Nursing Home Care Act as Intermediate
Care for
the |
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| Developmentally Disabled facilities or as long-term care |
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| facilities for
residents under 22 years of age, the rates |
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| taking effect on July 1,
2003 shall
include a statewide |
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| increase of 4%, as defined by the Department.
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| Rates established effective each July 1 shall govern |
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| payment
for services rendered throughout that fiscal year, |
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| except that rates
established on July 1, 1996 shall be |
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| increased by 6.8% for services
provided on or after January 1, |
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| 1997. Such rates will be based
upon the rates calculated for |
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| the year beginning July 1, 1990, and for
subsequent years |
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| thereafter until June 30, 2001 shall be based on the
facility |
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| cost reports
for the facility fiscal year ending at any point |
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| in time during the previous
calendar year, updated to the |
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| midpoint of the rate year. The cost report
shall be on file |
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| with the Department no later than April 1 of the current
rate |
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| year. Should the cost report not be on file by April 1, the |
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| Department
shall base the rate on the latest cost report filed |
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| by each skilled care
facility and intermediate care facility, |
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| updated to the midpoint of the
current rate year. In |
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| determining rates for services rendered on and after
July 1, |
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| 1985, fixed time shall not be computed at less than zero. The
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| Department shall not make any alterations of regulations which |
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| would reduce
any component of the Medicaid rate to a level |
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| below what that component would
have been utilizing in the rate |
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| effective on July 1, 1984.
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| (2) Shall take into account the actual costs incurred by |
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| facilities
in providing services for recipients of skilled |
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SB0063 Engrossed |
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LRB094 04047 DRJ 34066 b |
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| nursing and intermediate
care services under the medical |
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| assistance program.
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| (3) Shall take into account the medical and psycho-social
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| characteristics and needs of the patients.
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| (4) Shall take into account the actual costs incurred by |
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| facilities in
meeting licensing and certification standards |
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| imposed and prescribed by the
State of Illinois, any of its |
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| political subdivisions or municipalities and by
the U.S. |
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| Department of Health and Human Services pursuant to Title XIX |
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| of the
Social Security Act.
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| The Department of Public Aid shall develop precise |
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| standards for
payments to reimburse nursing facilities for any |
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| utilization of
appropriate rehabilitative personnel for the |
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| provision of rehabilitative
services which is authorized by |
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| federal regulations, including
reimbursement for services |
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| provided by qualified therapists or qualified
assistants, and |
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| which is in accordance with accepted professional
practices. |
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| Reimbursement also may be made for utilization of other
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| supportive personnel under appropriate supervision.
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| (Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597, |
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| eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20, |
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| eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, eff. 2-3-04; 93-841, |
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| eff. 7-30-04.)
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| Section 99. Effective date. This Act takes effect upon |
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| becoming law.
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