97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
SB0786

 

Introduced 2/8/2011, by Sen. John J. Cullerton

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.4  from Ch. 23, par. 5-5.4

    Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning standards of payment of skilled nursing and intermediate care services.


LRB097 04504 KTG 44543 b

 

 

A BILL FOR

 

SB0786LRB097 04504 KTG 44543 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
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 The Department of Healthcare and
9Family Services shall develop standards of payment of skilled
10nursing and intermediate care services in facilities providing
11such services under this Article which:
12    (1) Provide for the determination of a facility's payment
13for skilled nursing and intermediate care services on a
14prospective basis. The amount of the payment rate for all
15nursing facilities certified by the Department of Public Health
16under the MR/DD Community Care Act or the Nursing Home Care Act
17as Intermediate Care for the Developmentally Disabled
18facilities, Long Term Care for Under Age 22 facilities, Skilled
19Nursing facilities, or Intermediate Care facilities under the
20medical assistance program shall be prospectively established
21annually on the basis of historical, financial, and statistical
22data reflecting actual costs from prior years, which shall be
23applied to the current rate year and updated for inflation,

 

 

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1except that the capital cost element for newly constructed
2facilities shall be based upon projected budgets. The annually
3established payment rate shall take effect on July 1 in 1984
4and subsequent years. No rate increase and no update for
5inflation shall be provided on or after July 1, 1994 and before
6July 1, 2011, unless specifically provided for in this Section.
7The changes made by Public Act 93-841 extending the duration of
8the prohibition against a rate increase or update for inflation
9are effective retroactive to July 1, 2004.
10    For facilities licensed by the Department of Public Health
11under the Nursing Home Care Act as Intermediate Care for the
12Developmentally Disabled facilities or Long Term Care for Under
13Age 22 facilities, the rates taking effect on July 1, 1998
14shall include an increase of 3%. For facilities licensed by the
15Department of Public Health under the Nursing Home Care Act as
16Skilled Nursing facilities or Intermediate Care facilities,
17the rates taking effect on July 1, 1998 shall include an
18increase of 3% plus $1.10 per resident-day, as defined by the
19Department. For facilities licensed by the Department of Public
20Health under the Nursing Home Care Act as Intermediate Care
21Facilities for the Developmentally Disabled or Long Term Care
22for Under Age 22 facilities, the rates taking effect on January
231, 2006 shall include an increase of 3%. For facilities
24licensed by the Department of Public Health under the Nursing
25Home Care Act as Intermediate Care Facilities for the
26Developmentally Disabled or Long Term Care for Under Age 22

 

 

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1facilities, the rates taking effect on January 1, 2009 shall
2include an increase sufficient to provide a $0.50 per hour wage
3increase for non-executive staff.
4    For facilities licensed by the Department of Public Health
5under the Nursing Home Care Act as Intermediate Care for the
6Developmentally Disabled facilities or Long Term Care for Under
7Age 22 facilities, the rates taking effect on July 1, 1999
8shall include an increase of 1.6% plus $3.00 per resident-day,
9as defined by the Department. For facilities licensed by the
10Department of Public Health under the Nursing Home Care Act as
11Skilled Nursing facilities or Intermediate Care facilities,
12the rates taking effect on July 1, 1999 shall include an
13increase of 1.6% and, for services provided on or after October
141, 1999, shall be increased by $4.00 per resident-day, as
15defined by the Department.
16    For facilities licensed by the Department of Public Health
17under the Nursing Home Care Act as Intermediate Care for the
18Developmentally Disabled facilities or Long Term Care for Under
19Age 22 facilities, the rates taking effect on July 1, 2000
20shall include an increase of 2.5% per resident-day, as defined
21by the Department. For facilities licensed by the Department of
22Public Health under the Nursing Home Care Act as Skilled
23Nursing facilities or Intermediate Care facilities, the rates
24taking effect on July 1, 2000 shall include an increase of 2.5%
25per resident-day, as defined by the Department.
26    For facilities licensed by the Department of Public Health

 

 

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

 

 

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1    component rate per patient day under the payment
2    methodology in effect on July 1, 2003 than the facility
3    received effective on the date immediately preceding the
4    date that the Department implements the new payment
5    methodology, the nursing component rate per patient day for
6    the facility shall be adjusted.
7        (C) Notwithstanding paragraphs (A) and (B), the
8    nursing component rate per patient day for the facility
9    shall be adjusted subject to appropriations provided by the
10    General Assembly.
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 March 1, 2001
15shall include a statewide increase of 7.85%, as defined by the
16Department.
17    Notwithstanding any other provision of this Section, for
18facilities licensed by the Department of Public Health under
19the Nursing Home Care Act as skilled nursing facilities or
20intermediate care facilities, the numerator of the ratio used
21by the Department of Healthcare and Family Services to compute
22the rate payable under this Section using the Minimum Data Set
23(MDS) methodology shall incorporate the following annual
24amounts as the additional funds appropriated to the Department
25specifically to pay for rates based on the MDS nursing
26component methodology in excess of the funding in effect on

 

 

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1December 31, 2006:
2        (i) For rates taking effect January 1, 2007,
3    $60,000,000.
4        (ii) For rates taking effect January 1, 2008,
5    $110,000,000.
6        (iii) For rates taking effect January 1, 2009,
7    $194,000,000.
8    Notwithstanding any other provision of this Section, for
9facilities licensed by the Department of Public Health under
10the Nursing Home Care Act as skilled nursing facilities or
11intermediate care facilities, the support component of the
12rates taking effect on January 1, 2008 shall be computed using
13the most recent cost reports on file with the Department of
14Healthcare and Family Services no later than April 1, 2005,
15updated for inflation to January 1, 2006.
16    For facilities licensed by the Department of Public Health
17under the Nursing Home Care Act as Intermediate Care for the
18Developmentally Disabled facilities or Long Term Care for Under
19Age 22 facilities, the rates taking effect on April 1, 2002
20shall include a statewide increase of 2.0%, as defined by the
21Department. This increase terminates on July 1, 2002; beginning
22July 1, 2002 these rates are reduced to the level of the rates
23in effect on March 31, 2002, as defined by the Department.
24    For facilities licensed by the Department of Public Health
25under the Nursing Home Care Act as skilled nursing facilities
26or intermediate care facilities, the rates taking effect on

 

 

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1July 1, 2001 shall be computed using the most recent cost
2reports on file with the Department of Public Aid no later than
3April 1, 2000, updated for inflation to January 1, 2001. For
4rates effective July 1, 2001 only, rates shall be the greater
5of the rate computed for July 1, 2001 or the rate effective on
6June 30, 2001.
7    Notwithstanding any other provision of this Section, for
8facilities licensed by the Department of Public Health under
9the Nursing Home Care Act as skilled nursing facilities or
10intermediate care facilities, the Illinois Department shall
11determine by rule the rates taking effect on July 1, 2002,
12which shall be 5.9% less than the rates in effect on June 30,
132002.
14    Notwithstanding any other provision of this Section, for
15facilities licensed by the Department of Public Health under
16the Nursing Home Care Act as skilled nursing facilities or
17intermediate care facilities, if the payment methodologies
18required under Section 5A-12 and the waiver granted under 42
19CFR 433.68 are approved by the United States Centers for
20Medicare and Medicaid Services, the rates taking effect on July
211, 2004 shall be 3.0% greater than the rates in effect on June
2230, 2004. These rates shall take effect only upon approval and
23implementation of the payment methodologies required under
24Section 5A-12.
25    Notwithstanding any other provisions of this Section, for
26facilities licensed by the Department of Public Health under

 

 

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1the Nursing Home Care Act as skilled nursing facilities or
2intermediate care facilities, the rates taking effect on
3January 1, 2005 shall be 3% more than the rates in effect on
4December 31, 2004.
5    Notwithstanding any other provision of this Section, for
6facilities licensed by the Department of Public Health under
7the Nursing Home Care Act as skilled nursing facilities or
8intermediate care facilities, effective January 1, 2009, the
9per diem support component of the rates effective on January 1,
102008, computed using the most recent cost reports on file with
11the Department of Healthcare and Family Services no later than
12April 1, 2005, updated for inflation to January 1, 2006, shall
13be increased to the amount that would have been derived using
14standard Department of Healthcare and Family Services methods,
15procedures, and inflators.
16    Notwithstanding any other provisions of this Section, for
17facilities licensed by the Department of Public Health under
18the Nursing Home Care Act as intermediate care facilities that
19are federally defined as Institutions for Mental Disease, a
20socio-development component rate equal to 6.6% of the
21facility's nursing component rate as of January 1, 2006 shall
22be established and paid effective July 1, 2006. The
23socio-development component of the rate shall be increased by a
24factor of 2.53 on the first day of the month that begins at
25least 45 days after January 11, 2008 (the effective date of
26Public Act 95-707). As of August 1, 2008, the socio-development

 

 

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1component rate shall be equal to 6.6% of the facility's nursing
2component rate as of January 1, 2006, multiplied by a factor of
33.53. The Illinois Department may by rule adjust these
4socio-development component rates, but in no case may such
5rates be diminished.
6    For facilities licensed by the Department of Public Health
7under the Nursing Home Care Act as Intermediate Care for the
8Developmentally Disabled facilities or as long-term care
9facilities for residents under 22 years of age, the rates
10taking effect on July 1, 2003 shall include a statewide
11increase of 4%, as defined by the Department.
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 the first day of
16the month that begins at least 45 days after the effective date
17of this amendatory Act of the 95th General Assembly shall
18include a statewide increase of 2.5%, as defined by the
19Department.
20    Notwithstanding any other provision of this Section, for
21facilities licensed by the Department of Public Health under
22the Nursing Home Care Act as skilled nursing facilities or
23intermediate care facilities, effective January 1, 2005,
24facility rates shall be increased by the difference between (i)
25a facility's per diem property, liability, and malpractice
26insurance costs as reported in the cost report filed with the

 

 

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1Department of Public Aid and used to establish rates effective
2July 1, 2001 and (ii) those same costs as reported in the
3facility's 2002 cost report. These costs shall be passed
4through to the facility without caps or limitations, except for
5adjustments required under normal auditing procedures.
6    Rates established effective each July 1 shall govern
7payment for services rendered throughout that fiscal year,
8except that rates established on July 1, 1996 shall be
9increased by 6.8% for services provided on or after January 1,
101997. Such rates will be based upon the rates calculated for
11the year beginning July 1, 1990, and for subsequent years
12thereafter until June 30, 2001 shall be based on the facility
13cost reports for the facility fiscal year ending at any point
14in time during the previous calendar year, updated to the
15midpoint of the rate year. The cost report shall be on file
16with the Department no later than April 1 of the current rate
17year. Should the cost report not be on file by April 1, the
18Department shall base the rate on the latest cost report filed
19by each skilled care facility and intermediate care facility,
20updated to the midpoint of the current rate year. In
21determining rates for services rendered on and after July 1,
221985, fixed time shall not be computed at less than zero. The
23Department shall not make any alterations of regulations which
24would reduce any component of the Medicaid rate to a level
25below what that component would have been utilizing in the rate
26effective on July 1, 1984.

 

 

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1    (2) Shall take into account the actual costs incurred by
2facilities in providing services for recipients of skilled
3nursing and intermediate care services under the medical
4assistance program.
5    (3) Shall take into account the medical and psycho-social
6characteristics and needs of the patients.
7    (4) Shall take into account the actual costs incurred by
8facilities in meeting licensing and certification standards
9imposed and prescribed by the State of Illinois, any of its
10political subdivisions or municipalities and by the U.S.
11Department of Health and Human Services pursuant to Title XIX
12of the Social Security Act.
13    The Department of Healthcare and Family Services shall
14develop precise standards for payments to reimburse nursing
15facilities for any utilization of appropriate rehabilitative
16personnel for the provision of rehabilitative services which is
17authorized by federal regulations, including reimbursement for
18services provided by qualified therapists or qualified
19assistants, and which is in accordance with accepted
20professional practices. Reimbursement also may be made for
21utilization of other supportive personnel under appropriate
22supervision.
23(Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707,
24eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09;
2596-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff.
267-2-10.)