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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 Sections 5-4.2, 5-5.4, 5B-2, 5B-4, and 5B-8 as |
6 | | follows:
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7 | | (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
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8 | | Sec. 5-4.2. Ambulance services payments. |
9 | | (a) For
ambulance
services provided to a recipient of aid |
10 | | under this Article on or after
January 1, 1993, the Illinois |
11 | | Department shall reimburse ambulance service
providers at |
12 | | rates calculated in accordance with this Section. It is the |
13 | | intent
of the General Assembly to provide adequate |
14 | | reimbursement for ambulance
services so as to ensure adequate |
15 | | access to services for recipients of aid
under this Article and |
16 | | to provide appropriate incentives to ambulance service
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17 | | providers to provide services in an efficient and |
18 | | cost-effective manner. Thus,
it is the intent of the General |
19 | | Assembly that the Illinois Department implement
a |
20 | | reimbursement system for ambulance services that, to the extent |
21 | | practicable
and subject to the availability of funds |
22 | | appropriated by the General Assembly
for this purpose, is |
23 | | consistent with the payment principles of Medicare. To
ensure |
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1 | | uniformity between the payment principles of Medicare and |
2 | | Medicaid, the
Illinois Department shall follow, to the extent |
3 | | necessary and practicable and
subject to the availability of |
4 | | funds appropriated by the General Assembly for
this purpose, |
5 | | the statutes, laws, regulations, policies, procedures,
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6 | | principles, definitions, guidelines, and manuals used to |
7 | | determine the amounts
paid to ambulance service providers under |
8 | | Title XVIII of the Social Security
Act (Medicare).
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9 | | (b) For ambulance services provided to a recipient of aid |
10 | | under this Article
on or after January 1, 1996, the Illinois |
11 | | Department shall reimburse ambulance
service providers based |
12 | | upon the actual distance traveled if a natural
disaster, |
13 | | weather conditions, road repairs, or traffic congestion |
14 | | necessitates
the use of a
route other than the most direct |
15 | | route.
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16 | | (c) For purposes of this Section, "ambulance services" |
17 | | includes medical
transportation services provided by means of |
18 | | an ambulance, medi-car, service
car, or
taxi.
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19 | | (c-1) For purposes of this Section, "ground ambulance |
20 | | service" means medical transportation services that are |
21 | | described as ground ambulance services by the Centers for |
22 | | Medicare and Medicaid Services and provided in a vehicle that |
23 | | is licensed as an ambulance by the Illinois Department of |
24 | | Public Health pursuant to the Emergency Medical Services (EMS) |
25 | | Systems Act. |
26 | | (c-2) For purposes of this Section, "ground ambulance |
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1 | | service provider" means a vehicle service provider as described |
2 | | in the Emergency Medical Services (EMS) Systems Act that |
3 | | operates licensed ambulances for the purpose of providing |
4 | | emergency ambulance services, or non-emergency ambulance |
5 | | services, or both. For purposes of this Section, this includes |
6 | | both ambulance providers and ambulance suppliers as described |
7 | | by the Centers for Medicare and Medicaid Services. |
8 | | (d) This Section does not prohibit separate billing by |
9 | | ambulance service
providers for oxygen furnished while |
10 | | providing advanced life support
services.
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11 | | (e) Beginning with services rendered on or after July 1, |
12 | | 2008, all providers of non-emergency medi-car and service car |
13 | | transportation must certify that the driver and employee |
14 | | attendant, as applicable, have completed a safety program |
15 | | approved by the Department to protect both the patient and the |
16 | | driver, prior to transporting a patient.
The provider must |
17 | | maintain this certification in its records. The provider shall |
18 | | produce such documentation upon demand by the Department or its |
19 | | representative. Failure to produce documentation of such |
20 | | training shall result in recovery of any payments made by the |
21 | | Department for services rendered by a non-certified driver or |
22 | | employee attendant. Medi-car and service car providers must |
23 | | maintain legible documentation in their records of the driver |
24 | | and, as applicable, employee attendant that actually |
25 | | transported the patient. Providers must recertify all drivers |
26 | | and employee attendants every 3 years.
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1 | | Notwithstanding the requirements above, any public |
2 | | transportation provider of medi-car and service car |
3 | | transportation that receives federal funding under 49 U.S.C. |
4 | | 5307 and 5311 need not certify its drivers and employee |
5 | | attendants under this Section, since safety training is already |
6 | | federally mandated.
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7 | | (f) With respect to any policy or program administered by |
8 | | the Department or its agent regarding approval of non-emergency |
9 | | medical transportation by ground ambulance service providers, |
10 | | including, but not limited to, the Non-Emergency |
11 | | Transportation Services Prior Approval Program (NETSPAP), the |
12 | | Department shall establish by rule a process by which ground |
13 | | ambulance service providers of non-emergency medical |
14 | | transportation may appeal any decision by the Department or its |
15 | | agent for which no denial was received prior to the time of |
16 | | transport that either (i) denies a request for approval for |
17 | | payment of non-emergency transportation by means of ground |
18 | | ambulance service or (ii) grants a request for approval of |
19 | | non-emergency transportation by means of ground ambulance |
20 | | service at a level of service that entitles the ground |
21 | | ambulance service provider to a lower level of compensation |
22 | | from the Department than the ground ambulance service provider |
23 | | would have received as compensation for the level of service |
24 | | requested. The rule shall be established within 12 months after |
25 | | the effective date of this amendatory Act of the 97th General |
26 | | Assembly and shall provide that, for any decision rendered by |
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1 | | the Department or its agent on or after the date the rule takes |
2 | | effect, the ground ambulance service provider shall have 60 |
3 | | days from the date the decision is received to file an appeal. |
4 | | The rule established by the Department shall be, insofar as is |
5 | | practical, consistent with the Illinois Administrative |
6 | | Procedure Act. The Director's decision on an appeal under this |
7 | | Section shall be a final administrative decision subject to |
8 | | review under the Administrative Review Law. |
9 | | (Source: P.A. 95-501, eff. 8-28-07.)
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10 | | (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4) |
11 | | Sec. 5-5.4. Standards of Payment - Department of Healthcare |
12 | | and Family Services.
The Department of Healthcare and Family |
13 | | Services shall develop standards of payment of
nursing facility |
14 | | and ICF/DD services in facilities providing such services
under |
15 | | this Article which:
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16 | | (1) Provide for the determination of a facility's payment
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17 | | for nursing facility or ICF/DD services on a prospective basis.
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18 | | The amount of the payment rate for all nursing facilities |
19 | | certified by the
Department of Public Health under the MR/DD |
20 | | Community Care Act or the Nursing Home Care Act as Intermediate
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21 | | Care for the Developmentally Disabled facilities, Long Term |
22 | | Care for Under Age
22 facilities, Skilled Nursing facilities, |
23 | | or Intermediate Care facilities
under the
medical assistance |
24 | | program shall be prospectively established annually on the
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25 | | basis of historical, financial, and statistical data |
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1 | | reflecting actual costs
from prior years, which shall be |
2 | | applied to the current rate year and updated
for inflation, |
3 | | except that the capital cost element for newly constructed
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4 | | facilities shall be based upon projected budgets. The annually |
5 | | established
payment rate shall take effect on July 1 in 1984 |
6 | | and subsequent years. No rate
increase and no
update for |
7 | | inflation shall be provided on or after July 1, 1994 and before
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8 | | July 1, 2012, unless specifically provided for in this
Section.
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9 | | The changes made by Public Act 93-841
extending the duration of |
10 | | the prohibition against a rate increase or update for inflation |
11 | | are effective retroactive to July 1, 2004.
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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 July
1, 1998 |
16 | | shall include an increase of 3%. For facilities licensed by the
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17 | | Department of Public Health under the Nursing Home Care Act as |
18 | | Skilled Nursing
facilities or Intermediate Care facilities, |
19 | | the rates taking effect on July 1,
1998 shall include an |
20 | | increase of 3% plus $1.10 per resident-day, as defined by
the |
21 | | Department. For facilities licensed by the Department of Public |
22 | | Health under the Nursing Home Care Act as Intermediate Care |
23 | | Facilities for the Developmentally Disabled or Long Term Care |
24 | | for Under Age 22 facilities, the rates taking effect on January |
25 | | 1, 2006 shall include an increase of 3%.
For facilities |
26 | | licensed by the Department of Public Health under the Nursing |
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1 | | Home Care Act as Intermediate Care Facilities for the |
2 | | Developmentally Disabled or Long Term Care for Under Age 22 |
3 | | facilities, the rates taking effect on January 1, 2009 shall |
4 | | include an increase sufficient to provide a $0.50 per hour wage |
5 | | increase for non-executive staff. |
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 July 1, 1999 |
10 | | shall include an increase of 1.6% plus $3.00 per
resident-day, |
11 | | as defined by the Department. For facilities licensed by the
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12 | | Department of Public Health under the Nursing Home Care Act as |
13 | | Skilled Nursing
facilities or Intermediate Care facilities, |
14 | | the rates taking effect on July 1,
1999 shall include an |
15 | | increase of 1.6% and, for services provided on or after
October |
16 | | 1, 1999, shall be increased by $4.00 per resident-day, as |
17 | | defined by
the Department.
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18 | | For facilities licensed by the Department of Public Health |
19 | | under the
Nursing Home Care Act as Intermediate Care for the |
20 | | Developmentally Disabled
facilities or Long Term Care for Under |
21 | | Age 22 facilities, the rates taking
effect on July 1, 2000 |
22 | | shall include an increase of 2.5% per resident-day,
as defined |
23 | | by the Department. For facilities licensed by the Department of
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24 | | Public Health under the Nursing Home Care Act as Skilled |
25 | | Nursing facilities or
Intermediate Care facilities, the rates |
26 | | taking effect on July 1, 2000 shall
include an increase of 2.5% |
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1 | | per resident-day, as defined by the Department.
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2 | | For facilities licensed by the Department of Public Health |
3 | | under the
Nursing Home Care Act as skilled nursing facilities |
4 | | or intermediate care
facilities, a new payment methodology must |
5 | | be implemented for the nursing
component of the rate effective |
6 | | July 1, 2003. The Department of Public Aid
(now Healthcare and |
7 | | Family Services) shall develop the new payment methodology |
8 | | using the Minimum Data Set
(MDS) as the instrument to collect |
9 | | information concerning nursing home
resident condition |
10 | | necessary to compute the rate. The Department
shall develop the |
11 | | new payment methodology to meet the unique needs of
Illinois |
12 | | nursing home residents while remaining subject to the |
13 | | appropriations
provided by the General Assembly.
A transition |
14 | | period from the payment methodology in effect on June 30, 2003
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15 | | to the payment methodology in effect on July 1, 2003 shall be |
16 | | provided for a
period not exceeding 3 years and 184 days after |
17 | | implementation of the new payment
methodology as follows:
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18 | | (A) For a facility that would receive a lower
nursing |
19 | | component rate per patient day under the new system than |
20 | | the facility
received
effective on the date immediately |
21 | | preceding the date that the Department
implements the new |
22 | | payment methodology, the nursing component rate per |
23 | | patient
day for the facility
shall be held at
the level in |
24 | | effect on the date immediately preceding the date that the
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25 | | Department implements the new payment methodology until a |
26 | | higher nursing
component rate of
reimbursement is achieved |
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1 | | by that
facility.
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2 | | (B) For a facility that would receive a higher nursing |
3 | | component rate per
patient day under the payment |
4 | | methodology in effect on July 1, 2003 than the
facility |
5 | | received effective on the date immediately preceding the |
6 | | date that the
Department implements the new payment |
7 | | methodology, the nursing component rate
per patient day for |
8 | | the facility shall be adjusted.
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9 | | (C) Notwithstanding paragraphs (A) and (B), the |
10 | | nursing component rate per
patient day for the facility |
11 | | shall be adjusted subject to appropriations
provided by the |
12 | | General Assembly.
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13 | | For facilities licensed by the Department of Public Health |
14 | | under the
Nursing Home Care Act as Intermediate Care for the |
15 | | Developmentally Disabled
facilities or Long Term Care for Under |
16 | | Age 22 facilities, the rates taking
effect on March 1, 2001 |
17 | | shall include a statewide increase of 7.85%, as
defined by the |
18 | | Department.
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19 | | Notwithstanding any other provision of this Section, for |
20 | | facilities licensed by the Department of Public Health under |
21 | | the
Nursing Home Care Act as skilled nursing facilities or |
22 | | intermediate care
facilities, except facilities participating |
23 | | in the Department's demonstration program pursuant to the |
24 | | provisions of Title 77, Part 300, Subpart T of the Illinois |
25 | | Administrative Code, the numerator of the ratio used by the |
26 | | Department of Healthcare and Family Services to compute the |
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1 | | rate payable under this Section using the Minimum Data Set |
2 | | (MDS) methodology shall incorporate the following annual |
3 | | amounts as the additional funds appropriated to the Department |
4 | | specifically to pay for rates based on the MDS nursing |
5 | | component methodology in excess of the funding in effect on |
6 | | December 31, 2006: |
7 | | (i) For rates taking effect January 1, 2007, |
8 | | $60,000,000. |
9 | | (ii) For rates taking effect January 1, 2008, |
10 | | $110,000,000. |
11 | | (iii) For rates taking effect January 1, 2009, |
12 | | $194,000,000. |
13 | | (iv) For rates taking effect April 1, 2011, or the |
14 | | first day of the month that begins at least 45 days after |
15 | | the effective date of this amendatory Act of the 96th |
16 | | General Assembly, $416,500,000 or an amount as may be |
17 | | necessary to complete the transition to the MDS methodology |
18 | | for the nursing component of the rate. Increased payments |
19 | | under this item (iv) are not due and payable, however, |
20 | | until (i) the methodologies described in this paragraph are |
21 | | approved by the federal government in an appropriate State |
22 | | Plan amendment and (ii) the assessment imposed by Section |
23 | | 5B-2 of this Code is determined to be a permissible tax |
24 | | under Title XIX of the Social Security Act. |
25 | | Notwithstanding any other provision of this Section, for |
26 | | facilities licensed by the Department of Public Health under |
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1 | | the Nursing Home Care Act as skilled nursing facilities or |
2 | | intermediate care facilities, the support component of the |
3 | | rates taking effect on January 1, 2008 shall be computed using |
4 | | the most recent cost reports on file with the Department of |
5 | | Healthcare and Family Services no later than April 1, 2005, |
6 | | updated for inflation to January 1, 2006. |
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 April 1, 2002 |
11 | | shall include a statewide increase of 2.0%, as
defined by the |
12 | | Department.
This increase terminates on July 1, 2002;
beginning |
13 | | July 1, 2002 these rates are reduced to the level of the rates
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14 | | in effect on March 31, 2002, as defined by the Department.
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15 | | For facilities licensed by the Department of Public Health |
16 | | under the
Nursing Home Care Act as skilled nursing facilities |
17 | | or intermediate care
facilities, the rates taking effect on |
18 | | July 1, 2001 shall be computed using the most recent cost |
19 | | reports
on file with the Department of Public Aid no later than |
20 | | April 1, 2000,
updated for inflation to January 1, 2001. For |
21 | | rates effective July 1, 2001
only, rates shall be the greater |
22 | | of the rate computed for July 1, 2001
or the rate effective on |
23 | | June 30, 2001.
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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 |
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1 | | intermediate care facilities, the Illinois
Department shall |
2 | | determine by rule the rates taking effect on July 1, 2002,
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3 | | which shall be 5.9% less than the rates in effect on June 30, |
4 | | 2002.
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5 | | Notwithstanding any other provision of this Section, for |
6 | | facilities
licensed by the Department of Public Health under |
7 | | the Nursing Home Care Act as
skilled nursing
facilities or |
8 | | intermediate care facilities, if the payment methodologies |
9 | | required under Section 5A-12 and the waiver granted under 42 |
10 | | CFR 433.68 are approved by the United States Centers for |
11 | | Medicare and Medicaid Services, the rates taking effect on July |
12 | | 1, 2004 shall be 3.0% greater than the rates in effect on June |
13 | | 30, 2004. These rates shall take
effect only upon approval and
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14 | | implementation of the payment methodologies required under |
15 | | Section 5A-12.
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16 | | Notwithstanding any other provisions of this Section, for |
17 | | facilities licensed by the Department of Public Health under |
18 | | the Nursing Home Care Act as skilled nursing facilities or |
19 | | intermediate care facilities, the rates taking effect on |
20 | | January 1, 2005 shall be 3% more than the rates in effect on |
21 | | December 31, 2004.
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22 | | Notwithstanding any other provision of this Section, for |
23 | | facilities licensed by the Department of Public Health under |
24 | | the Nursing Home Care Act as skilled nursing facilities or |
25 | | intermediate care facilities, effective January 1, 2009, the |
26 | | per diem support component of the rates effective on January 1, |
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1 | | 2008, computed using the most recent cost reports on file with |
2 | | the Department of Healthcare and Family Services no later than |
3 | | April 1, 2005, updated for inflation to January 1, 2006, shall |
4 | | be increased to the amount that would have been derived using |
5 | | standard Department of Healthcare and Family Services methods, |
6 | | procedures, and inflators. |
7 | | Notwithstanding any other provisions of this Section, for |
8 | | facilities licensed by the Department of Public Health under |
9 | | the Nursing Home Care Act as intermediate care facilities that |
10 | | are federally defined as Institutions for Mental Disease, a |
11 | | socio-development component rate equal to 6.6% of the |
12 | | facility's nursing component rate as of January 1, 2006 shall |
13 | | be established and paid effective July 1, 2006. The |
14 | | socio-development component of the rate shall be increased by a |
15 | | factor of 2.53 on the first day of the month that begins at |
16 | | least 45 days after January 11, 2008 (the effective date of |
17 | | Public Act 95-707). As of August 1, 2008, the socio-development |
18 | | component rate shall be equal to 6.6% of the facility's nursing |
19 | | component rate as of January 1, 2006, multiplied by a factor of |
20 | | 3.53. For services provided on or after April 1, 2011, or the |
21 | | first day of the month that begins at least 45 days after the |
22 | | effective date of this amendatory Act of the 96th General |
23 | | Assembly, whichever is later, the Illinois Department may by |
24 | | rule adjust these socio-development component rates, and may |
25 | | use different adjustment methodologies for those facilities |
26 | | participating, and those not participating, in the Illinois |
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1 | | Department's demonstration program pursuant to the provisions |
2 | | of Title 77, Part 300, Subpart T of the Illinois Administrative |
3 | | Code, but in no case may such rates be diminished below those |
4 | | in effect on August 1, 2008.
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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 as long-term care |
8 | | facilities for
residents under 22 years of age, the rates |
9 | | taking effect on July 1,
2003 shall
include a statewide |
10 | | increase of 4%, as defined by the Department.
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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 Long Term Care for Under |
14 | | Age 22 facilities, the rates taking
effect on the first day of |
15 | | the month that begins at least 45 days after the effective date |
16 | | of this amendatory Act of the 95th General Assembly shall |
17 | | include a statewide increase of 2.5%, as
defined by the |
18 | | Department. |
19 | | Notwithstanding any other provision of this Section, for |
20 | | facilities licensed by the Department of Public Health under |
21 | | the Nursing Home Care Act as skilled nursing facilities or |
22 | | intermediate care facilities, effective January 1, 2005, |
23 | | facility rates shall be increased by the difference between (i) |
24 | | a facility's per diem property, liability, and malpractice |
25 | | insurance costs as reported in the cost report filed with the |
26 | | Department of Public Aid and used to establish rates effective |
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1 | | July 1, 2001 and (ii) those same costs as reported in the |
2 | | facility's 2002 cost report. These costs shall be passed |
3 | | through to the facility without caps or limitations, except for |
4 | | adjustments required under normal auditing procedures.
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5 | | Rates established effective each July 1 shall govern |
6 | | payment
for services rendered throughout that fiscal year, |
7 | | except that rates
established on July 1, 1996 shall be |
8 | | increased by 6.8% for services
provided on or after January 1, |
9 | | 1997. Such rates will be based
upon the rates calculated for |
10 | | the year beginning July 1, 1990, and for
subsequent years |
11 | | thereafter until June 30, 2001 shall be based on the
facility |
12 | | cost reports
for the facility fiscal year ending at any point |
13 | | in time during the previous
calendar year, updated to the |
14 | | midpoint of the rate year. The cost report
shall be on file |
15 | | with the Department no later than April 1 of the current
rate |
16 | | year. Should the cost report not be on file by April 1, the |
17 | | Department
shall base the rate on the latest cost report filed |
18 | | by each skilled care
facility and intermediate care facility, |
19 | | updated to the midpoint of the
current rate year. In |
20 | | determining rates for services rendered on and after
July 1, |
21 | | 1985, fixed time shall not be computed at less than zero. The
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22 | | Department shall not make any alterations of regulations which |
23 | | would reduce
any component of the Medicaid rate to a level |
24 | | below what that component would
have been utilizing in the rate |
25 | | effective on July 1, 1984.
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26 | | (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 Healthcare and Family Services
shall |
13 | | develop precise standards for
payments to reimburse nursing |
14 | | facilities for any utilization of
appropriate rehabilitative |
15 | | personnel for the provision of rehabilitative
services which is |
16 | | authorized by federal regulations, including
reimbursement for |
17 | | services provided by qualified therapists or qualified
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18 | | assistants, and which is in accordance with accepted |
19 | | professional
practices. Reimbursement also may be made for |
20 | | utilization of other
supportive personnel under appropriate |
21 | | supervision.
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22 | | The Department shall develop enhanced payments to offset |
23 | | the additional costs incurred by a
facility serving exceptional |
24 | | need residents and shall allocate at least $8,000,000 of the |
25 | | funds
collected from the assessment established by Section 5B-2 |
26 | | of this Code for such payments. For
the purpose of this |
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1 | | Section, "exceptional needs" means, but need not be limited to, |
2 | | ventilator care, tracheotomy care,
bariatric care, complex |
3 | | wound care, and traumatic brain injury care. The enhanced |
4 | | payments for exceptional need residents under this paragraph |
5 | | are not due and payable, however, until (i) the methodologies |
6 | | described in this paragraph are approved by the federal |
7 | | government in an appropriate State Plan amendment and (ii) the |
8 | | assessment imposed by Section 5B-2 of this Code is determined |
9 | | to be a permissible tax under Title XIX of the Social Security |
10 | | Act. |
11 | | (5) Beginning July 1, 2012 the methodologies for |
12 | | reimbursement of nursing facility services as provided under |
13 | | this Section 5-5.4 shall no longer be applicable for bills |
14 | | payable for State fiscal years 2012 and thereafter. |
15 | | (6) No payment increase under this Section for the MDS |
16 | | methodology, exceptional care residents, or the |
17 | | socio-development component rate established by Public Act |
18 | | 96-1530 of the 96th General Assembly and funded by the |
19 | | assessment imposed under Section 5B-2 of this Code shall be due |
20 | | and payable until after the Department notifies the long-term |
21 | | care providers, in writing, that the payment methodologies to |
22 | | long-term care providers required under this Section have been |
23 | | approved by the Centers for Medicare and Medicaid Services of |
24 | | the U.S. Department of Health and Human Services and the |
25 | | waivers under 42 CFR 433.68 for the assessment imposed by this |
26 | | Section, if necessary, have been granted by the Centers for |
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1 | | Medicare and Medicaid Services of the U.S. Department of Health |
2 | | and Human Services. Upon notification to the Department of |
3 | | approval of the payment methodologies required under this |
4 | | Section and the waivers granted under 42 CFR 433.68, all |
5 | | increased payments otherwise due under this Section prior to |
6 | | the date of notification shall be due and payable within 90 |
7 | | days of the date federal approval is received. |
8 | | (Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707, |
9 | | eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09; |
10 | | 96-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10; |
11 | | 96-1530, eff. 2-16-11.)
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12 | | (305 ILCS 5/5B-2) (from Ch. 23, par. 5B-2)
|
13 | | Sec. 5B-2. Assessment; no local authorization to tax.
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14 | | (a) For the privilege of engaging in the occupation of |
15 | | long-term care
provider, beginning July 1, 2011 an assessment |
16 | | is imposed upon each long-term care provider in an amount equal |
17 | | to $6.07 times the number of occupied bed days due and payable |
18 | | each month. Notwithstanding any provision of any other Act to |
19 | | the
contrary, this assessment shall be construed as a tax, but |
20 | | shall not be billed or passed on to any resident of a nursing |
21 | | home operated by the nursing home provider may not be added
to |
22 | | the charges of an individual's nursing home care that is paid |
23 | | for in
whole, or in part, by a federal, State, or combined |
24 | | federal-state medical
care program .
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25 | | (b) Nothing in this amendatory Act of 1992 shall be |
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1 | | construed to
authorize any home rule unit or other unit of |
2 | | local government to license
for revenue or impose a tax or |
3 | | assessment upon long-term care providers or
the occupation of |
4 | | long-term care provider, or a tax or assessment measured
by the |
5 | | income or earnings or occupied bed days of a long-term care |
6 | | provider.
|
7 | | (c) The assessment imposed by this Section shall not be due |
8 | | and payable, however, until after the Department notifies the |
9 | | long-term care providers, in writing, that the payment |
10 | | methodologies to long-term care providers required under |
11 | | Section 5-5.4 of this Code have been approved by the Centers |
12 | | for Medicare and Medicaid Services of the U.S. Department of |
13 | | Health and Human Services and the waivers under 42 CFR 433.68 |
14 | | for the assessment imposed by this Section, if necessary, have |
15 | | been granted by the Centers for Medicare and Medicaid Services |
16 | | of the U.S. Department of Health and Human Services. |
17 | | (Source: P.A. 96-1530, eff. 2-16-11.)
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18 | | (305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)
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19 | | Sec. 5B-4. Payment of assessment; penalty.
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20 | | (a) The assessment imposed by Section 5B-2 shall be due and |
21 | | payable monthly, on the last State business day of the month |
22 | | for occupied bed days reported for the preceding third month |
23 | | prior to the month in which the tax is payable and due. A |
24 | | facility that has delayed payment due to the State's failure to |
25 | | reimburse for services rendered may request an extension on the |
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1 | | due date for payment pursuant to subsection (b) and shall pay |
2 | | the assessment within 30 days of reimbursement by the |
3 | | Department.
The Illinois Department may provide that county |
4 | | nursing homes directed and
maintained pursuant to Section |
5 | | 5-1005 of the Counties Code may meet their
assessment |
6 | | obligation by certifying to the Illinois Department that county
|
7 | | expenditures have been obligated for the operation of the |
8 | | county nursing
home in an amount at least equal to the amount |
9 | | of the assessment.
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10 | | (a-5) Each assessment payment shall be accompanied by an |
11 | | assessment report to be completed by the long-term care |
12 | | provider. A separate report shall be completed for each |
13 | | long-term care facility in this State operated by a long-term |
14 | | care provider. The report shall be in a form and manner |
15 | | prescribed by the Illinois Department and shall at a minimum |
16 | | provide for the reporting of the number of occupied bed days of |
17 | | the long-term care facility for the reporting period and other |
18 | | reasonable information the Illinois Department requires for |
19 | | the administration of its responsibilities under this Code. To |
20 | | the extent practicable, the Department shall coordinate the |
21 | | assessment reporting requirements with other reporting |
22 | | required of long-term care facilities. |
23 | | (b) The Illinois Department is authorized to establish
|
24 | | delayed payment schedules for long-term care providers that are
|
25 | | unable to make assessment payments when due under this Section
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26 | | due to financial difficulties, as determined by the Illinois
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1 | | Department. The Illinois Department may not deny a request for |
2 | | delay of payment of the assessment imposed under this Article |
3 | | if the long-term care provider has not been paid for services |
4 | | provided during the month on which the assessment is levied.
|
5 | | (c) If a long-term care provider fails to pay the full
|
6 | | amount of an assessment payment when due (including any |
7 | | extensions
granted under subsection (b)), there shall, unless |
8 | | waived by the
Illinois Department for reasonable cause, be |
9 | | added to the
assessment imposed by Section 5B-2 a
penalty |
10 | | assessment equal to the lesser of (i) 5% of the amount of
the |
11 | | assessment payment not paid on or before the due date plus 5% |
12 | | of the
portion thereof remaining unpaid on the last day of each |
13 | | month
thereafter or (ii) 100% of the assessment payment amount |
14 | | not paid on or
before the due date. For purposes of this |
15 | | subsection, payments
will be credited first to unpaid |
16 | | assessment payment amounts (rather than
to penalty or |
17 | | interest), beginning with the most delinquent assessment |
18 | | payments. Payment cycles of longer than 60 days shall be one |
19 | | factor the Director takes into account in granting a waiver |
20 | | under this Section.
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21 | | (c-5) If a long-term care provider fails to file its report |
22 | | with payment, there shall, unless waived by the Illinois |
23 | | Department for reasonable cause, be added to the assessment due |
24 | | a penalty assessment equal to 25% of the assessment due. |
25 | | (d) Nothing in this amendatory Act of 1993 shall be |
26 | | construed to prevent
the Illinois Department from collecting |
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1 | | all amounts due under this Article
pursuant to an assessment |
2 | | imposed before the effective date of this amendatory
Act of |
3 | | 1993.
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4 | | (e) Nothing in this amendatory Act of the 96th General |
5 | | Assembly shall be construed to prevent
the Illinois Department |
6 | | from collecting all amounts due under this Code
pursuant to an |
7 | | assessment, tax, fee, or penalty imposed before the effective |
8 | | date of this amendatory
Act of the 96th General Assembly. |
9 | | (f) No installment of the assessment imposed by Section |
10 | | 5B-2 shall be due and payable until after the Department |
11 | | notifies the long-term care providers, in writing, that the |
12 | | payment methodologies to long-term care providers required |
13 | | under Section 5-5.4 of this Code have been approved by the |
14 | | Centers for Medicare and Medicaid Services of the U.S. |
15 | | Department of Health and Human Services and the waivers under |
16 | | 42 CFR 433.68 for the assessment imposed by this Section, if |
17 | | necessary, have been granted by the Centers for Medicare and |
18 | | Medicaid Services of the U.S. Department of Health and Human |
19 | | Services. Upon notification to the Department of approval of |
20 | | the payment methodologies required under Section 5-5.4 of this |
21 | | Code and the waivers granted under 42 CFR 433.68, all |
22 | | installments otherwise due under Section 5B-4 prior to the date |
23 | | of notification shall be due and payable to the Department upon |
24 | | written direction from the Department within 90 days after |
25 | | issuance by the Comptroller of the payments required under |
26 | | Section 5-5.4 of this Code. |
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1 | | (Source: P.A. 96-444, eff. 8-14-09; 96-1530, eff. 2-16-11.)
|
2 | | (305 ILCS 5/5B-8) (from Ch. 23, par. 5B-8)
|
3 | | Sec. 5B-8. Long-Term Care Provider Fund.
|
4 | | (a) There is created in the State Treasury the Long-Term
|
5 | | Care Provider Fund. Interest earned by the Fund shall be
|
6 | | credited to the Fund. The Fund shall not be used to replace any
|
7 | | moneys appropriated to the Medicaid program by the General |
8 | | Assembly.
|
9 | | (b) The Fund is created for the purpose of receiving and
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10 | | disbursing moneys in accordance with this Article. |
11 | | Disbursements
from the Fund shall be made only as follows:
|
12 | | (1) For payments to nursing
facilities, including |
13 | | county nursing facilities but excluding
State-operated |
14 | | facilities, under Title XIX of the Social Security
Act and |
15 | | Article V of this Code.
|
16 | | (2) For the reimbursement of moneys collected by the
|
17 | | Illinois Department through error or mistake.
|
18 | | (3) For payment of administrative expenses incurred by |
19 | | the
Illinois Department or its agent in performing the |
20 | | activities
authorized by this Article.
|
21 | | (3.5) For reimbursement of expenses incurred by |
22 | | long-term care facilities, and payment of administrative |
23 | | expenses incurred by the Department of Public Health, in |
24 | | relation to the conduct and analysis of background checks |
25 | | for identified offenders under the Nursing Home Care Act.
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1 | | (4) For payments of any amounts that are reimbursable |
2 | | to the
federal government for payments from this Fund that |
3 | | are required
to be paid by State warrant.
|
4 | | (5) For making transfers to the General Obligation Bond
|
5 | | Retirement and Interest Fund, as those transfers are |
6 | | authorized
in the proceedings authorizing debt under the |
7 | | Short Term Borrowing Act,
but transfers made under this |
8 | | paragraph (5) shall not exceed the
principal amount of debt |
9 | | issued in anticipation of the receipt by
the State of |
10 | | moneys to be deposited into the Fund.
|
11 | | (6) For making transfers, at the direction of the |
12 | | Director of the Governor's Office of Management and Budget |
13 | | during each fiscal year beginning on or after July 1, 2011, |
14 | | to other State funds in an annual amount of $20,000,000 of |
15 | | the tax collected pursuant to this Article for the purpose |
16 | | of enforcement of nursing home standards, support of the |
17 | | ombudsman program, and efforts to expand home and |
18 | | community-based services. No transfer under this paragraph |
19 | | shall occur until (i) the payment methodologies created by |
20 | | Public Act 96-1530 under Section 5-5.4 of this Code have |
21 | | been approved by the Centers for Medicare and Medicaid |
22 | | Services of the U.S. Department of Health and Human |
23 | | Services and (ii) the assessment imposed by Section 5B-2 of |
24 | | this Code is determined to be a permissible tax under Title |
25 | | XIX of the Social Security Act. |
26 | | Disbursements from the Fund, other than transfers made |
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1 | | pursuant to paragraphs (5) and (6) of this subsection, shall be |
2 | | by
warrants drawn by the State Comptroller upon receipt of |
3 | | vouchers
duly executed and certified by the Illinois |
4 | | Department.
|
5 | | (c) The Fund shall consist of the following:
|
6 | | (1) All moneys collected or received by the Illinois
|
7 | | Department from the long-term care provider assessment |
8 | | imposed by
this Article.
|
9 | | (2) All federal matching funds received by the Illinois
|
10 | | Department as a result of expenditures made by the Illinois
|
11 | | Department that are attributable to moneys deposited in the |
12 | | Fund.
|
13 | | (3) Any interest or penalty levied in conjunction with |
14 | | the
administration of this Article.
|
15 | | (4) (Blank).
|
16 | | (5) All other monies received for the Fund from any |
17 | | other source,
including interest earned thereon.
|
18 | | (Source: P.A. 95-707, eff. 1-11-08; 96-1530, eff. 2-16-11.)
|
19 | | Section 99. Effective date. This Act takes effect upon |
20 | | becoming law. |