Sen. Toi W. Hutchinson

Filed: 4/8/2013

 

 


 

 


 
09800SB1368sam001LRB098 09909 KTG 43079 a

1
AMENDMENT TO SENATE BILL 1368

2    AMENDMENT NO. ______. Amend Senate Bill 1368 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Public Aid Code is amended by
5changing Section 5-5.4 as follows:
 
6    (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
7    Sec. 5-5.4. Standards of Payment - Department of Healthcare
8and Family Services. The Department of Healthcare and Family
9Services shall develop standards of payment of nursing facility
10and ICF/DD services in facilities providing such services under
11this Article which:
12    (1) Provide for the determination of a facility's payment
13for nursing facility or ICF/DD services on a prospective basis.
14The amount of the payment rate for all nursing facilities
15certified by the Department of Public Health under the ID/DD
16Community Care Act or the Nursing Home Care Act as Intermediate

 

 

09800SB1368sam001- 2 -LRB098 09909 KTG 43079 a

1Care for the Developmentally Disabled facilities, Long Term
2Care for Under Age 22 facilities, Skilled Nursing facilities,
3or Intermediate Care facilities under the medical assistance
4program shall be prospectively established annually on the
5basis of historical, financial, and statistical data
6reflecting actual costs from prior years, which shall be
7applied to the current rate year and updated for inflation,
8except that the capital cost element for newly constructed
9facilities shall be based upon projected budgets. The annually
10established payment rate shall take effect on July 1 in 1984
11and subsequent years. No rate increase and no update for
12inflation shall be provided on or after July 1, 1994 and before
13January 1, 2014, unless specifically provided for in this
14Section. The changes made by Public Act 93-841 extending the
15duration of the prohibition against a rate increase or update
16for inflation are effective retroactive to July 1, 2004.
17    For facilities licensed by the Department of Public Health
18under the Nursing Home Care Act as Intermediate Care for the
19Developmentally Disabled facilities or Long Term Care for Under
20Age 22 facilities, the rates taking effect on July 1, 1998
21shall include an increase of 3%. For facilities licensed by the
22Department of Public Health under the Nursing Home Care Act as
23Skilled Nursing facilities or Intermediate Care facilities,
24the rates taking effect on July 1, 1998 shall include an
25increase of 3% plus $1.10 per resident-day, as defined by the
26Department. For facilities licensed by the Department of Public

 

 

09800SB1368sam001- 3 -LRB098 09909 KTG 43079 a

1Health under the Nursing Home Care Act as Intermediate Care
2Facilities for the Developmentally Disabled or Long Term Care
3for Under Age 22 facilities, the rates taking effect on January
41, 2006 shall include an increase of 3%. For facilities
5licensed by the Department of Public Health under the Nursing
6Home Care Act as Intermediate Care Facilities for the
7Developmentally Disabled or Long Term Care for Under Age 22
8facilities, the rates taking effect on January 1, 2009 shall
9include an increase sufficient to provide a $0.50 per hour wage
10increase for non-executive staff.
11    For facilities licensed by the Department of Public Health
12under the Nursing Home Care Act as Intermediate Care for the
13Developmentally Disabled facilities or Long Term Care for Under
14Age 22 facilities, the rates taking effect on July 1, 1999
15shall include an increase of 1.6% plus $3.00 per resident-day,
16as defined by the Department. For facilities licensed by the
17Department of Public Health under the Nursing Home Care Act as
18Skilled Nursing facilities or Intermediate Care facilities,
19the rates taking effect on July 1, 1999 shall include an
20increase of 1.6% and, for services provided on or after October
211, 1999, shall be increased by $4.00 per resident-day, as
22defined by the Department.
23    For facilities licensed by the Department of Public Health
24under the Nursing Home Care Act as Intermediate Care for the
25Developmentally Disabled facilities or Long Term Care for Under
26Age 22 facilities, the rates taking effect on July 1, 2000

 

 

09800SB1368sam001- 4 -LRB098 09909 KTG 43079 a

1shall include an increase of 2.5% per resident-day, as defined
2by the Department. For facilities licensed by the Department of
3Public Health under the Nursing Home Care Act as Skilled
4Nursing facilities or Intermediate Care facilities, the rates
5taking effect on July 1, 2000 shall include an increase of 2.5%
6per resident-day, as defined by the Department.
7    For facilities licensed by the Department of Public Health
8under the Nursing Home Care Act as skilled nursing facilities
9or intermediate care facilities, a new payment methodology must
10be implemented for the nursing component of the rate effective
11July 1, 2003. The Department of Public Aid (now Healthcare and
12Family Services) shall develop the new payment methodology
13using the Minimum Data Set (MDS) as the instrument to collect
14information concerning nursing home resident condition
15necessary to compute the rate. The Department shall develop the
16new payment methodology to meet the unique needs of Illinois
17nursing home residents while remaining subject to the
18appropriations provided by the General Assembly. A transition
19period from the payment methodology in effect on June 30, 2003
20to the payment methodology in effect on July 1, 2003 shall be
21provided for a period not exceeding 3 years and 184 days after
22implementation of the new payment methodology as follows:
23        (A) For a facility that would receive a lower nursing
24    component rate per patient day under the new system than
25    the facility received effective on the date immediately
26    preceding the date that the Department implements the new

 

 

09800SB1368sam001- 5 -LRB098 09909 KTG 43079 a

1    payment methodology, the nursing component rate per
2    patient day for the facility shall be held at the level in
3    effect on the date immediately preceding the date that the
4    Department implements the new payment methodology until a
5    higher nursing component rate of reimbursement is achieved
6    by that facility.
7        (B) For a facility that would receive a higher nursing
8    component rate per patient day under the payment
9    methodology in effect on July 1, 2003 than the facility
10    received effective on the date immediately preceding the
11    date that the Department implements the new payment
12    methodology, the nursing component rate per patient day for
13    the facility shall be adjusted.
14        (C) Notwithstanding paragraphs (A) and (B), the
15    nursing component rate per patient day for the facility
16    shall be adjusted subject to appropriations provided by the
17    General Assembly.
18    For facilities licensed by the Department of Public Health
19under the Nursing Home Care Act as Intermediate Care for the
20Developmentally Disabled facilities or Long Term Care for Under
21Age 22 facilities, the rates taking effect on March 1, 2001
22shall include a statewide increase of 7.85%, as defined by the
23Department.
24    Notwithstanding any other provision of this Section, for
25facilities licensed by the Department of Public Health under
26the Nursing Home Care Act as skilled nursing facilities or

 

 

09800SB1368sam001- 6 -LRB098 09909 KTG 43079 a

1intermediate care facilities, except facilities participating
2in the Department's demonstration program pursuant to the
3provisions of Title 77, Part 300, Subpart T of the Illinois
4Administrative Code, the numerator of the ratio used by the
5Department of Healthcare and Family Services to compute the
6rate payable under this Section using the Minimum Data Set
7(MDS) methodology shall incorporate the following annual
8amounts as the additional funds appropriated to the Department
9specifically to pay for rates based on the MDS nursing
10component methodology in excess of the funding in effect on
11December 31, 2006:
12        (i) For rates taking effect January 1, 2007,
13    $60,000,000.
14        (ii) For rates taking effect January 1, 2008,
15    $110,000,000.
16        (iii) For rates taking effect January 1, 2009,
17    $194,000,000.
18        (iv) For rates taking effect April 1, 2011, or the
19    first day of the month that begins at least 45 days after
20    the effective date of this amendatory Act of the 96th
21    General Assembly, $416,500,000 or an amount as may be
22    necessary to complete the transition to the MDS methodology
23    for the nursing component of the rate. Increased payments
24    under this item (iv) are not due and payable, however,
25    until (i) the methodologies described in this paragraph are
26    approved by the federal government in an appropriate State

 

 

09800SB1368sam001- 7 -LRB098 09909 KTG 43079 a

1    Plan amendment and (ii) the assessment imposed by Section
2    5B-2 of this Code is determined to be a permissible tax
3    under Title XIX of the Social Security Act.
4    Notwithstanding any other provision of this Section, for
5facilities licensed by the Department of Public Health under
6the Nursing Home Care Act as skilled nursing facilities or
7intermediate care facilities, the support component of the
8rates taking effect on January 1, 2008 shall be computed using
9the most recent cost reports on file with the Department of
10Healthcare and Family Services no later than April 1, 2005,
11updated for inflation to January 1, 2006.
12    For facilities licensed by the Department of Public Health
13under the Nursing Home Care Act as Intermediate Care for the
14Developmentally Disabled facilities or Long Term Care for Under
15Age 22 facilities, the rates taking effect on April 1, 2002
16shall include a statewide increase of 2.0%, as defined by the
17Department. This increase terminates on July 1, 2002; beginning
18July 1, 2002 these rates are reduced to the level of the rates
19in effect on March 31, 2002, as defined by the Department.
20    For facilities licensed by the Department of Public Health
21under the Nursing Home Care Act as skilled nursing facilities
22or intermediate care facilities, the rates taking effect on
23July 1, 2001 shall be computed using the most recent cost
24reports on file with the Department of Public Aid no later than
25April 1, 2000, updated for inflation to January 1, 2001. For
26rates effective July 1, 2001 only, rates shall be the greater

 

 

09800SB1368sam001- 8 -LRB098 09909 KTG 43079 a

1of the rate computed for July 1, 2001 or the rate effective on
2June 30, 2001.
3    Notwithstanding any other provision of this Section, for
4facilities licensed by the Department of Public Health under
5the Nursing Home Care Act as skilled nursing facilities or
6intermediate care facilities, the Illinois Department shall
7determine by rule the rates taking effect on July 1, 2002,
8which shall be 5.9% less than the rates in effect on June 30,
92002.
10    Notwithstanding any other provision of this Section, for
11facilities licensed by the Department of Public Health under
12the Nursing Home Care Act as skilled nursing facilities or
13intermediate care facilities, if the payment methodologies
14required under Section 5A-12 and the waiver granted under 42
15CFR 433.68 are approved by the United States Centers for
16Medicare and Medicaid Services, the rates taking effect on July
171, 2004 shall be 3.0% greater than the rates in effect on June
1830, 2004. These rates shall take effect only upon approval and
19implementation of the payment methodologies required under
20Section 5A-12.
21    Notwithstanding any other provisions of this Section, for
22facilities licensed by the Department of Public Health under
23the Nursing Home Care Act as skilled nursing facilities or
24intermediate care facilities, the rates taking effect on
25January 1, 2005 shall be 3% more than the rates in effect on
26December 31, 2004.

 

 

09800SB1368sam001- 9 -LRB098 09909 KTG 43079 a

1    Notwithstanding any other provision of this Section, for
2facilities licensed by the Department of Public Health under
3the Nursing Home Care Act as skilled nursing facilities or
4intermediate care facilities, effective January 1, 2009, the
5per diem support component of the rates effective on January 1,
62008, computed using the most recent cost reports on file with
7the Department of Healthcare and Family Services no later than
8April 1, 2005, updated for inflation to January 1, 2006, shall
9be increased to the amount that would have been derived using
10standard Department of Healthcare and Family Services methods,
11procedures, and inflators.
12    Notwithstanding any other provisions of this Section, for
13facilities licensed by the Department of Public Health under
14the Nursing Home Care Act as intermediate care facilities that
15are federally defined as Institutions for Mental Disease, or
16facilities licensed by the Department of Public Health under
17the Specialized Mental Health Rehabilitation Act, a
18socio-development component rate equal to 6.6% of the
19facility's nursing component rate as of January 1, 2006 shall
20be established and paid effective July 1, 2006. The
21socio-development component of the rate shall be increased by a
22factor of 2.53 on the first day of the month that begins at
23least 45 days after January 11, 2008 (the effective date of
24Public Act 95-707). As of August 1, 2008, the socio-development
25component rate shall be equal to 6.6% of the facility's nursing
26component rate as of January 1, 2006, multiplied by a factor of

 

 

09800SB1368sam001- 10 -LRB098 09909 KTG 43079 a

13.53. For services provided on or after April 1, 2011, or the
2first day of the month that begins at least 45 days after the
3effective date of this amendatory Act of the 96th General
4Assembly, whichever is later, the Illinois Department may by
5rule adjust these socio-development component rates, and may
6use different adjustment methodologies for those facilities
7participating, and those not participating, in the Illinois
8Department's demonstration program pursuant to the provisions
9of Title 77, Part 300, Subpart T of the Illinois Administrative
10Code, but in no case may such rates be diminished below those
11in effect on August 1, 2008.
12    For facilities licensed by the Department of Public Health
13under the Nursing Home Care Act as Intermediate Care for the
14Developmentally Disabled facilities or as long-term care
15facilities for residents under 22 years of age, the rates
16taking effect on July 1, 2003 shall include a statewide
17increase of 4%, as defined by the Department.
18    For facilities licensed by the Department of Public Health
19under the Nursing Home Care Act as Intermediate Care for the
20Developmentally Disabled facilities or Long Term Care for Under
21Age 22 facilities, the rates taking effect on the first day of
22the month that begins at least 45 days after the effective date
23of this amendatory Act of the 95th General Assembly shall
24include a statewide increase of 2.5%, as defined by the
25Department.
26    Notwithstanding any other provision of this Section, for

 

 

09800SB1368sam001- 11 -LRB098 09909 KTG 43079 a

1facilities licensed by the Department of Public Health under
2the Nursing Home Care Act as skilled nursing facilities or
3intermediate care facilities, effective January 1, 2005,
4facility rates shall be increased by the difference between (i)
5a facility's per diem property, liability, and malpractice
6insurance costs as reported in the cost report filed with the
7Department of Public Aid and used to establish rates effective
8July 1, 2001 and (ii) those same costs as reported in the
9facility's 2002 cost report. These costs shall be passed
10through to the facility without caps or limitations, except for
11adjustments required under normal auditing procedures.
12    Rates established effective each July 1 shall govern
13payment for services rendered throughout that fiscal year,
14except that rates established on July 1, 1996 shall be
15increased by 6.8% for services provided on or after January 1,
161997. Such rates will be based upon the rates calculated for
17the year beginning July 1, 1990, and for subsequent years
18thereafter until June 30, 2001 shall be based on the facility
19cost reports for the facility fiscal year ending at any point
20in time during the previous calendar year, updated to the
21midpoint of the rate year. The cost report shall be on file
22with the Department no later than April 1 of the current rate
23year. Should the cost report not be on file by April 1, the
24Department shall base the rate on the latest cost report filed
25by each skilled care facility and intermediate care facility,
26updated to the midpoint of the current rate year. In

 

 

09800SB1368sam001- 12 -LRB098 09909 KTG 43079 a

1determining rates for services rendered on and after July 1,
21985, fixed time shall not be computed at less than zero. The
3Department shall not make any alterations of regulations which
4would reduce any component of the Medicaid rate to a level
5below what that component would have been utilizing in the rate
6effective on July 1, 1984.
7    (2) Shall take into account the actual costs incurred by
8facilities in providing services for recipients of skilled
9nursing and intermediate care services under the medical
10assistance program.
11    (3) Shall take into account the medical and psycho-social
12characteristics and needs of the patients.
13    (4) Shall take into account the actual costs incurred by
14facilities in meeting licensing and certification standards
15imposed and prescribed by the State of Illinois, any of its
16political subdivisions or municipalities and by the U.S.
17Department of Health and Human Services pursuant to Title XIX
18of the Social Security Act.
19    The Department of Healthcare and Family Services shall
20develop precise standards for payments to reimburse nursing
21facilities for any utilization of appropriate rehabilitative
22personnel for the provision of rehabilitative services which is
23authorized by federal regulations, including reimbursement for
24services provided by qualified therapists or qualified
25assistants, and which is in accordance with accepted
26professional practices. Reimbursement also may be made for

 

 

09800SB1368sam001- 13 -LRB098 09909 KTG 43079 a

1utilization of other supportive personnel under appropriate
2supervision.
3    The Department shall develop enhanced payments to offset
4the additional costs incurred by a facility serving exceptional
5need residents and shall allocate at least $8,000,000 of the
6funds collected from the assessment established by Section 5B-2
7of this Code for such payments. For the purpose of this
8Section, "exceptional needs" means, but need not be limited to,
9ventilator care, tracheotomy care, bariatric care, complex
10wound care, and traumatic brain injury care. The enhanced
11payments for exceptional need residents under this paragraph
12are not due and payable, however, until (i) the methodologies
13described in this paragraph are approved by the federal
14government in an appropriate State Plan amendment and (ii) the
15assessment imposed by Section 5B-2 of this Code is determined
16to be a permissible tax under Title XIX of the Social Security
17Act.
18    Beginning January 1, 2014 the methodologies for
19reimbursement of nursing facility services as provided under
20this Section 5-5.4 shall no longer be applicable for services
21provided on or after January 1, 2014.
22    No payment increase under this Section for the MDS
23methodology, exceptional care residents, or the
24socio-development component rate established by Public Act
2596-1530 of the 96th General Assembly and funded by the
26assessment imposed under Section 5B-2 of this Code shall be due

 

 

09800SB1368sam001- 14 -LRB098 09909 KTG 43079 a

1and payable until after the Department notifies the long-term
2care providers, in writing, that the payment methodologies to
3long-term care providers required under this Section have been
4approved by the Centers for Medicare and Medicaid Services of
5the U.S. Department of Health and Human Services and the
6waivers under 42 CFR 433.68 for the assessment imposed by this
7Section, if necessary, have been granted by the Centers for
8Medicare and Medicaid Services of the U.S. Department of Health
9and Human Services. Upon notification to the Department of
10approval of the payment methodologies required under this
11Section and the waivers granted under 42 CFR 433.68, all
12increased payments otherwise due under this Section prior to
13the date of notification shall be due and payable within 90
14days of the date federal approval is received.
15    On and after July 1, 2012, the Department shall reduce any
16rate of reimbursement for services or other payments or alter
17any methodologies authorized by this Code to reduce any rate of
18reimbursement for services or other payments in accordance with
19Section 5-5e.
20    For facilities licensed by the Department of Public Health
21under the ID/DD Community Care Act as Intermediate Care
22Facilities for the Developmentally Disabled or Long Term Care
23for Under Age 22 facilities, the rates taking effect on July 1,
242013 shall include an increase sufficient to provide a $1 per
25hour wage increase for direct care staff, front-line
26supervisors, nurses, and non-administrative support staff.

 

 

09800SB1368sam001- 15 -LRB098 09909 KTG 43079 a

1(Source: P.A. 96-45, eff. 7-15-09; 96-339, eff. 7-1-10; 96-959,
2eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1530, eff. 2-16-11;
397-10, eff. 6-14-11; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12;
497-584, eff. 8-26-11; 97-689, eff. 6-14-12; 97-813, eff.
57-13-12.)
 
6    Section 99. Effective date. This Act takes effect July 1,
72013.".