Sen. Heather A. Steans

Filed: 4/7/2016

 

 


 

 


 
09900SB0419sam001LRB099 03251 KTG 47095 a

1
AMENDMENT TO SENATE BILL 419

2    AMENDMENT NO. ______. Amend Senate Bill 419 by replacing
3everything after the enacting clause with the following:
 
4    "Section 1. Findings. The General Assembly finds as
5follows:
6        (1) It is in the best interest of the citizens of
7    Illinois to review and update Medicaid payment
8    methodologies to ensure the best use of public resources.
9        (2) The intent of the $6.07 tax per occupied bed day
10    imposed by Public Act 96-1530 was to pay for increased
11    staffing under Public Act 96-1372.
12        (3) Many nursing homes are still staffed below the
13    legal level required under Section 3-202.05 of the Nursing
14    Home Care Act.
15        (4) Some low-staffed homes have gained from the higher
16    Medicaid rates but have not increased staffing.
17        (5) Policy research has noted the significant positive

 

 

09900SB0419sam001- 2 -LRB099 03251 KTG 47095 a

1    relationship between nursing home staffing levels and
2    quality of care.
3        (6) The State of Illinois desires to pay for value and
4    quality not just volume.
5        (7) The use of regional wage adjusters rewards or
6    penalizes nursing homes solely on location and does not
7    account for staffing levels or actual wages paid.
 
8    Section 5. The Illinois Public Aid Code is amended by
9changing Section 5-5.2 as follows:
 
10    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
11    Sec. 5-5.2. Payment.
12    (a) All nursing facilities that are grouped pursuant to
13Section 5-5.1 of this Act shall receive the same rate of
14payment for similar services.
15    (b) It shall be a matter of State policy that the Illinois
16Department shall utilize a uniform billing cycle throughout the
17State for the long-term care providers.
18    (c) Notwithstanding any other provisions of this Code, the
19methodologies for reimbursement of nursing services as
20provided under this Article shall no longer be applicable for
21bills payable for nursing services rendered on or after a new
22reimbursement system based on the Resource Utilization Groups
23(RUGs) has been fully operationalized, which shall take effect
24for services provided on or after January 1, 2014.

 

 

09900SB0419sam001- 3 -LRB099 03251 KTG 47095 a

1    (d) The new nursing services reimbursement methodology
2utilizing RUG-IV 48 grouper model, which shall be referred to
3as the RUGs reimbursement system, taking effect January 1,
42014, shall be based on the following:
5        (1) The methodology shall be resident-driven,
6    facility-specific, and cost-based.
7        (2) Costs shall be annually rebased and case mix index
8    quarterly updated. The nursing services methodology will
9    be assigned to the Medicaid enrolled residents on record as
10    of 30 days prior to the beginning of the rate period in the
11    Department's Medicaid Management Information System (MMIS)
12    as present on the last day of the second quarter preceding
13    the rate period based upon the Assessment Reference Date of
14    the Minimum Data Set (MDS).
15        (3) Facility-specific staffing levels and wages paid.
16    Regional wage adjustors based on the Health Service Areas
17    (HSA) groupings and adjusters in effect on April 30, 2012
18    shall be included.
19        (4) Case mix index shall be assigned to each resident
20    class based on the Centers for Medicare and Medicaid
21    Services staff time measurement study in effect on July 1,
22    2013, utilizing an index maximization approach.
23        (5) The pool of funds available for distribution by
24    case mix and the base facility rate shall be determined
25    using the formula contained in subsection (d-1).
26    (d-1) Calculation of base year Statewide RUG-IV nursing

 

 

09900SB0419sam001- 4 -LRB099 03251 KTG 47095 a

1base per diem rate, for dates of service beginning January 1,
22014 through December 31, 2016.
3        (1) Base rate spending pool shall be:
4            (A) The base year resident days which are
5        calculated by multiplying the number of Medicaid
6        residents in each nursing home as indicated in the MDS
7        data defined in paragraph (4) by 365.
8            (B) Each facility's nursing component per diem in
9        effect on July 1, 2012 shall be multiplied by
10        subsection (A).
11            (C) Thirteen million is added to the product of
12        subparagraph (A) and subparagraph (B) to adjust for the
13        exclusion of nursing homes defined in paragraph (5).
14        (2) For each nursing home with Medicaid residents as
15    indicated by the MDS data defined in paragraph (4),
16    weighted days adjusted for case mix and regional wage
17    adjustment shall be calculated. For each home this
18    calculation is the product of:
19            (A) Base year resident days as calculated in
20        subparagraph (A) of paragraph (1).
21            (B) The nursing home's regional wage adjustor
22        based on the Health Service Areas (HSA) groupings and
23        adjustors in effect on April 30, 2012.
24            (C) Facility weighted case mix which is the number
25        of Medicaid residents as indicated by the MDS data
26        defined in paragraph (4) multiplied by the associated

 

 

09900SB0419sam001- 5 -LRB099 03251 KTG 47095 a

1        case weight for the RUG-IV 48 grouper model using
2        standard RUG-IV procedures for index maximization.
3            (D) The sum of the products calculated for each
4        nursing home in subparagraphs (A) through (C) above
5        shall be the base year case mix, rate adjusted weighted
6        days.
7        (3) The Statewide RUG-IV nursing base per diem rate:
8            (A) on January 1, 2014 shall be the quotient of the
9        paragraph (1) divided by the sum calculated under
10        subparagraph (D) of paragraph (2); and
11            (B) on and after July 1, 2014, shall be the amount
12        calculated under subparagraph (A) of this paragraph
13        (3) plus $1.76.
14        (4) Minimum Data Set (MDS) comprehensive assessments
15    for Medicaid residents on the last day of the quarter used
16    to establish the base rate.
17        (5) Nursing facilities designated as of July 1, 2012 by
18    the Department as "Institutions for Mental Disease" shall
19    be excluded from all calculations under this subsection.
20    The data from these facilities shall not be used in the
21    computations described in paragraphs (1) through (4) above
22    to establish the base rate.
23    (e) Beginning July 1, 2014, the Department shall allocate
24funding in the amount up to $10,000,000 for per diem add-ons to
25the RUGS methodology for dates of service on and after July 1,
262014:

 

 

09900SB0419sam001- 6 -LRB099 03251 KTG 47095 a

1        (1) $0.63 for each resident who scores in I4200
2    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
3        (2) $2.67 for each resident who scores either a "1" or
4    "2" in any items S1200A through S1200I and also scores in
5    RUG groups PA1, PA2, BA1, or BA2.
6    (e-1) (Blank).
7    (e-2) For dates of services beginning January 1, 2014
8through December 31, 2016, the RUG-IV nursing component per
9diem for a nursing home shall be the product of the statewide
10RUG-IV nursing base per diem rate, the facility average case
11mix index, and the regional wage adjustor. Transition rates for
12services provided between January 1, 2014 and December 31, 2014
13shall be as follows:
14        (1) The transition RUG-IV per diem nursing rate for
15    nursing homes whose rate calculated in this subsection
16    (e-2) is greater than the nursing component rate in effect
17    July 1, 2012 shall be paid the sum of:
18            (A) The nursing component rate in effect July 1,
19        2012; plus
20            (B) The difference of the RUG-IV nursing component
21        per diem calculated for the current quarter minus the
22        nursing component rate in effect July 1, 2012
23        multiplied by 0.88.
24        (2) The transition RUG-IV per diem nursing rate for
25    nursing homes whose rate calculated in this subsection
26    (e-2) is less than the nursing component rate in effect

 

 

09900SB0419sam001- 7 -LRB099 03251 KTG 47095 a

1    July 1, 2012 shall be paid the sum of:
2            (A) The nursing component rate in effect July 1,
3        2012; plus
4            (B) The difference of the RUG-IV nursing component
5        per diem calculated for the current quarter minus the
6        nursing component rate in effect July 1, 2012
7        multiplied by 0.13.
8    (e-3) Calculation of facility-specific RUG-IV nursing
9component per diem rate for dates of service beginning January
101, 2017.
11        (1) The facility-specific RUG-IV nursing component per
12    diem rate must be the product of:
13            (A) The Statewide RUG-IV base rate of $85.25.
14            (B) The staffing and wage adjuster which is
15        assigned per facility based on the facility's specific
16        total per resident per day staffing wage cost as
17        defined in paragraph (2) of this subsection. For levels
18        defined in paragraph (3) of this subsection, the
19        staffing wage adjuster is:
20                (i) 0.80 for a facility with a total per
21            resident per day staffing wage cost less than level
22            1, or a facility whose staffing level is below the
23            intermediate care minimum required under Section
24            3-202.05 of the Nursing Home Care Act even if the
25            facility has a total per resident per day staffing
26            wage cost greater than or equal to level 1;

 

 

09900SB0419sam001- 8 -LRB099 03251 KTG 47095 a

1                (ii) 1.22 for a facility with a total per
2            resident per day staffing wage cost greater than or
3            equal to level 1 but less than level 2;
4                (iii) 1.42 for a facility with a total per
5            resident per day staffing wage cost greater than or
6            equal to level 2 but less than level 3;
7                (iv) 1.45 for a facility with a total per
8            resident per day staffing wage cost greater than or
9            equal to level 3; or
10                (v) 0.80 for a facility without data necessary
11            to calculate the facility's specific total per
12            resident per day staffing wage cost as defined in
13            paragraph (2) of this subsection.
14            (C) The facility weighted case mix, which is the
15        number of Medicaid residents as indicated by the
16        Minimum Data Set (MDS) data defined in paragraph (4) of
17        this subsection multiplied by the associated case
18        weight for the RUG-IV 48 grouper model using standard
19        RUG-IV procedures for index maximization.
20            (D) The ratio of actual staffing hours to total
21        expected staffing hours adjuster which is assigned
22        based on each facility's ratio as defined in paragraph
23        (5) of this subsection. The facilities are divided into
24        4 quartiles sorted from lowest to highest based on the
25        facility's ratio. The quartile with the lowest ratios
26        is quartile 1 and the quartile with the highest ratios

 

 

09900SB0419sam001- 9 -LRB099 03251 KTG 47095 a

1        is quartile 4 with quartile 2 and quartile 3 assigned
2        based on the ratios in those quartiles in relation to
3        lowest and highest quartiles. Facilities without
4        reported data are assigned to quartile 3. The quartiles
5        are calculated quarterly during regular rate updates.
6        The adjuster for each quartile is as follows:
7                (i) 0.65 for facilities in quartile 1;
8                (ii) the ratio defined in paragraph (5) of this
9            subsection for facilities in quartile 2 and 3; or
10                (iii) 1.00 for facilities in quartile 4.
11        (2) The staffing and wage adjuster under subparagraph
12    (B) of paragraph (1) of this subsection must be updated
13    each quarter using the staffing hours and wage data from
14    Payroll Benefit Journal data collected by the Centers for
15    Medicare and Medicaid Services for the same time period of
16    MDS data used to calculate the RUG-IV acuity case weight.
17    For the purposes of this Section, each facility's "total
18    per resident per day staffing wage cost" is calculated by
19    summing:
20            (A) The product of registered nurses' hours worked
21        per resident day multiplied by the reported hourly
22        wage. For the Director of Nursing only the number of
23        hours allowed under Section 3-202.05 of the Nursing
24        Home Care Act for the calculation of staffing ratios
25        may be included; plus
26            (B) The product of licensed practical nurses'

 

 

09900SB0419sam001- 10 -LRB099 03251 KTG 47095 a

1        worked hours per resident day multiplied by the
2        reported hourly wage; plus
3            (C) The product of certified nurse assistants'
4        hours worked per resident day multiplied by the
5        reported hourly wage; plus
6            (D) For all other staff considered direct care
7        staff under staffing ratios described in Section
8        3-202.05 of the Nursing Home Care Act, the product of
9        each remaining direct care staff type hours worked per
10        resident day multiplied by the reported hourly wage for
11        the direct care staff category at the same levels
12        allowed under the staffing ratios under Section
13        3-202.05 of the Nursing Home Care Act.
14        (3) The levels used to assign the staffing and wage
15    adjuster under subparagraph (B) of paragraph (1) of this
16    subsection shall be calculated using the staffing ratios
17    required under Section 3-202.05 of the Nursing Home Care
18    Act multiplied by the Illinois mean hourly wage for the
19    equivalent occupational code and title assigned by the U.S.
20    Bureau of Labor Statistics and reported in the May 2014
21    State Occupational Employment and Wage Estimates for
22    Illinois. The Department may, as established by rule, use
23    more current data from the same data set when made
24    available. The levels are:
25            (A) Level 1 is equal to the sum of:
26                (i) The product of 10% of the minimum staffing

 

 

09900SB0419sam001- 11 -LRB099 03251 KTG 47095 a

1            hours per resident day for intermediate care under
2            Section 3-202.05 of the Nursing Home Care Act
3            multiplied by the Illinois mean hourly wage for
4            registered nurses occupation code 29-1141 from the
5            U.S. Bureau of Labor Statistics data set described
6            in paragraph (3) of this subsection; plus
7                (ii) The product of 15% of the minimum staffing
8            hours per resident day for intermediate care under
9            Section 3-202.05 of the Nursing Home Care Act
10            multiplied by the Illinois mean hourly wage for
11            licensed practical nurses occupation code 29-2061
12            from the U.S. Bureau of Labor Statistics data set
13            described in paragraph (3) of this subsection;
14            plus
15                (iii) The product of 75% of the minimum
16            staffing hours per resident day for intermediate
17            care under Section 3-202.05 of the Nursing Home
18            Care Act multiplied by the Illinois mean hourly
19            wage for nursing assistants occupation code
20            31-1014 from the U.S. Bureau of Labor Statistics
21            data set described in paragraph (3) of this
22            subsection.
23            (B) Level 2 is equal to the sum of:
24                (i) The product of 10% of the minimum staffing
25            hours per resident day for skilled care under
26            Section 3-202.05 of the Nursing Home Care Act

 

 

09900SB0419sam001- 12 -LRB099 03251 KTG 47095 a

1            multiplied by the Illinois mean hourly wage for
2            registered nurses occupation code 29-1141 from the
3            U.S. Bureau of Labor Statistics data set described
4            in paragraph (3) of this subsection; plus
5                (ii) The product of 15% of the minimum staffing
6            hours per resident day for skilled care under
7            Section 3-202.05 of the Nursing Home Care Act
8            multiplied by the Illinois mean hourly wage for
9            licensed practical nurses occupation code 29-2061
10            from the U.S. Bureau of Labor Statistics set
11            described in paragraph (3) of this subsection;
12            plus
13                (iii) The product of 75% of the minimum
14            staffing hours per resident day for skilled care
15            under Section 3-202.05 of the Nursing Home Care Act
16            multiplied by the Illinois mean hourly wage for
17            nursing assistants occupation code 31-1014 from
18            the U.S. Bureau of Labor Statistics data set
19            described in paragraph (3) of this subsection.
20            (C) Level 3 is equal to the sum of:
21                (i) The product of .84 staffing hours per
22            resident day multiplied by the Illinois mean
23            hourly wage for registered nurses occupation code
24            29-1141 from the U.S. Bureau of Labor Statistics
25            data set described in paragraph (3) of this
26            subsection; plus

 

 

09900SB0419sam001- 13 -LRB099 03251 KTG 47095 a

1                (ii) The product of .84 staffing hours per
2            resident day multiplied by the Illinois mean
3            hourly wage for licensed practical nurses
4            occupation code 29-2061 from the U.S. Bureau of
5            Labor Statistics data set described in paragraph
6            (3) of this subsection; plus
7                (iii) The product of 2.46 staffing hours per
8            resident day multiplied by the Illinois mean
9            hourly wage for nursing assistants occupation code
10            31-1014 from the U.S. Bureau of Labor Statistics
11            data set described in paragraph (3) of this
12            subsection.
13        (4) Minimum Data Set comprehensive assessments for
14    Medicaid residents on the last day of the quarter used to
15    establish the rate.
16        (5) The facility-specific total ratio of actual
17    staffing hours to total expected staffing hours for the
18    assigned resident specific case weight must be updated each
19    quarter using the staffing hours and wage data from Payroll
20    Benefit Journal data collected by the Centers for Medicare
21    and Medicaid Services for the same time period of MDS data
22    used to calculate the RUG-IV acuity case weight. For each
23    facility the Department must calculate the total hours
24    worked per resident day for direct care staff allowed by
25    the staffing ratios under Section 3-202.05 of the Nursing
26    Home Care Act and divide that value by the sum of staffing

 

 

09900SB0419sam001- 14 -LRB099 03251 KTG 47095 a

1    hours per resident day assigned to each resident based on
2    the sum of the Resident Specific Time and Direct
3    Non-Resident Specific Time for the resident's RUG-IV
4    group. This is the same methodology for the Medicare 5-star
5    rating program calculation of the expected staffing hours
6    per resident day used by the Centers for Medicare and
7    Medicaid Services, except that the Centers for Medicare and
8    Medicaid Services uses RUG-III groupings.
9        (6) If the Payroll Benefit Journal data collected by
10    the Centers for Medicare and Medicaid Services is not
11    available, the Department must use the most recent cost
12    reporting data reported to the Department and the most
13    recent survey data posted to the Centers for Medicare and
14    Medicaid Services' Nursing Home Compare website. The
15    Department must use the Payroll Benefit Journal data
16    collected by the Centers for Medicare and Medicaid Services
17    once the data is available.
18    (e-4) Budget stability beginning January 1, 2017.
19        (1) Beginning January 1, 2017 and annually thereafter,
20    the Department may adjust, by administrative rule and
21    within the parameters established under this subsection
22    (e-4), the staffing and wage adjuster described in
23    subparagraph (B) of paragraph (1) of subsection (e-3) and
24    the ratio of actual staffing hours to the total expected
25    staffing hours adjuster described in subparagraph (D) of
26    paragraph (1) of subsection (e-3) for the purpose of

 

 

09900SB0419sam001- 15 -LRB099 03251 KTG 47095 a

1    keeping liability created by the facility-specific RUG-IV
2    nursing component per diem rates stable as defined in
3    paragraph (2) and paragraph (3) of this subsection (e-4).
4        (2) Budget stability for facility-specific RUG-IV
5    nursing component per diem rates effective January 1, 2017.
6    If the aggregate budget stability ratio calculated under
7    paragraph (4) of this subsection is greater than 0.96, then
8    the Department must adjust one or both of the adjusters
9    specified in paragraph (1) of this subsection in order to
10    decrease the ratio to no less than 0.96.
11        (3) Budget stability for facility-specific RUG-IV
12    nursing component per diem rates effective January 1, 2018
13    and annually thereafter. If the aggregate budget stability
14    ratio calculated under paragraph (4) of this subsection is
15    between 0.99 and 1.01, the Department must not make any
16    adjustments. If the aggregate budget stability ratio
17    calculated under paragraph (4) of this subsection is less
18    than 0.99, then the Department must adjust one or both of
19    the adjusters specified in paragraph (1) of this subsection
20    in order to increase the ratio to at least 0.99. If the
21    aggregate budget stability ratio calculated under
22    paragraph (4) of this subsection is greater than 1.01, then
23    the Department must adjust one or both of the adjusters
24    specified in paragraph (1) of this subsection in order to
25    decrease the ratio to at least 1.01, but no less than 1.00.
26        (4) For the purposes of this Section, the aggregate

 

 

09900SB0419sam001- 16 -LRB099 03251 KTG 47095 a

1    budget stability ratio calculated with the numerator
2    described in subparagraph (A) of this paragraph (4) divided
3    by the denominator described in subparagraph (B) of this
4    paragraph (4) is as follows:
5            (A) Numerator equal to the sum of the following
6        products:
7                (i) the product of the number of Medicaid
8            residents in each nursing home as indicated in the
9            MDS data defined in paragraph (4) of subsection
10            (e-3) multiplied by 365; then multiplied by
11                (ii) each nursing home's specific rate under
12            paragraph (1) of subsection (e-3). This rate does
13            not include the per diem add-ons defined in
14            subsection (e) of this Section.
15            (B) Denominator equal to the sum of the following
16        products:
17                (i) the product of the number of Medicaid
18            residents in each nursing home as indicated in the
19            MDS data defined in paragraph (4) of subsection
20            (e-3) multiplied by 365; then multiplied by
21                (ii) each nursing home's specific rate
22            effective July 1, 2015 under subsection (e-2).
23            This rate does not include the per diem add-ons
24            defined in subsection (e) of this Section.
25        (5) If adjustments are necessary under this subsection
26    (e-4), the staffing and wage adjuster described in

 

 

09900SB0419sam001- 17 -LRB099 03251 KTG 47095 a

1    subparagraph (B) of paragraph (1) of subsection (e-3) must
2    be adjusted within the following parameters:
3            (A) the adjuster for facilities with a total per
4        resident per day staffing wage cost less than level 1
5        must never be greater than 0.80;
6            (B) the adjuster for facilities with a total per
7        resident per day staffing wage cost less than level 1
8        must be lower than the adjusters for the other levels;
9            (C) the adjuster for facilities with a total per
10        resident per day staffing wage cost less than level 1
11        must generate an aggregate cost coverage for nursing
12        homes qualifying for that adjuster less than or equal
13        to 70% using the most recent cost data from cost
14        reports filed with the Department. The cost coverage
15        for the nursing homes qualifying for that adjuster must
16        have the lowest cost coverage as compared to the other
17        3 groups;
18            (D) the adjusters for the middle 2 levels must
19        generate the best possible aggregate cost coverage for
20        nursing homes qualifying for those adjusters of all the
21        adjusters using the most recent cost data from cost
22        reports filed with the Department; and
23            (E) the adjuster for facilities with a total per
24        resident per day staffing wage cost greater than level
25        4 must generate an aggregate cost coverage for nursing
26        homes qualifying for that adjuster less than or equal

 

 

09900SB0419sam001- 18 -LRB099 03251 KTG 47095 a

1        to 80% using the most recent cost data from cost
2        reports filed with the Department.
3            (F) Any limitations in this paragraph (5) based on
4        cost coverage must use the most recent cost data from
5        cost reports filed with the Department and must be
6        calculated after any adjustments have been made to the
7        ratio of actual staffing hours to total expected
8        staffing hours adjuster described in subparagraph (D)
9        of paragraph (1) of subsection (e-3) and limited by
10        paragraph (6) of this subsection (e-4).
11        (6) If adjustments are necessary under this subsection
12    (e-4), the ratio of actual staffing hours to total expected
13    staffing hours adjuster described in subparagraph (D) of
14    paragraph (1) of subsection (e-3) must be adjusted within
15    the following parameters:
16            (A) the adjuster for quartile 4 which has the best
17        acuity based staffing ratio must never be less than
18        1.00;
19            (B) the adjuster for quartile 1 must be the
20        smallest of all 4 quartile adjusters and must never be
21        greater than 0.65;
22            (C) the Department may set a specific adjuster for
23        quartile 2 and quartile 3 as opposed to the
24        facility-specific ratio defined in paragraph (5) of
25        subsection (e-3) which is allowed under subparagraph
26        (D) of paragraph (1) of subsection (e-3). If the

 

 

09900SB0419sam001- 19 -LRB099 03251 KTG 47095 a

1        Department sets a specific adjuster for quartile 2 or
2        quartile 3, then the adjuster for quartile 3 must not
3        be greater than the adjuster for quartile 4 or less
4        than the adjuster for quartile 2. The adjuster for
5        quartile 2 must not be greater than the adjuster for
6        quartile 3 or less than the adjuster for quartile 1;
7        and
8            (D) no quartile may have an adjuster greater than
9        1.00.
10        (7) For the purposes of this Section, cost coverage for
11    a facility is the facility-specific RUG-IV nursing
12    component per diem rate divided by the healthcare program
13    cost per day. The healthcare program cost per day is
14    calculated using data from cost reports submitted to the
15    Department as required under the Illinois Public Aid Code
16    and the Department's administrative rules. The Department
17    may update the cost report references in this paragraph by
18    administrative rule should the Department's cost report be
19    altered, as long as the updated references result in
20    identification of the identical or equivalent data and does
21    not materially change the resulting calculations. If the
22    Department has made changes from an audit, the Department
23    may use column 10 instead of column 8 of the respective
24    cost report lines cited in this paragraph (7) if the
25    information is made publicly available at the time of
26    making any calculations required in this Section. The

 

 

09900SB0419sam001- 20 -LRB099 03251 KTG 47095 a

1    healthcare program cost per day is the quotient of:
2            (A) the sum of the following costs as reported on
3        schedule V. of the Department's cost report;
4                (i) the total adjusted health care and
5            programs costs as reported on line 16 column 8;
6            plus
7                (ii) the total adjusted provider participation
8            fee costs as reported on line 42 column 8; plus
9                (iii) the total allocated cost of employee
10            benefits for health care employees calculated as
11            the total adjusted health care and programs salary
12            and wage costs as reported on line 16 column 1
13            divided by the product of the grand total salary
14            and wages as reported on line 45 column 1
15            multiplied by the total adjusted employee benefits
16            and payroll taxes as report on line 22 column 8;
17            (B) divided by the total patient days reported on
18        schedule III line 14 column 5 of the Department's cost
19        report.
20    (f) Notwithstanding any other provision of this Code, on
21and after July 1, 2012, reimbursement rates associated with the
22nursing or support components of the current nursing facility
23rate methodology shall not increase beyond the level effective
24May 1, 2011 until a new reimbursement system based on the RUGs
25IV 48 grouper model has been fully operationalized.
26    (g) Notwithstanding any other provision of this Code, on

 

 

09900SB0419sam001- 21 -LRB099 03251 KTG 47095 a

1and after July 1, 2012, for facilities not designated by the
2Department of Healthcare and Family Services as "Institutions
3for Mental Disease", rates effective May 1, 2011 shall be
4adjusted as follows:
5        (1) Individual nursing rates for residents classified
6    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
7    ending March 31, 2012 shall be reduced by 10%;
8        (2) Individual nursing rates for residents classified
9    in all other RUG IV groups shall be reduced by 1.0%;
10        (3) Facility rates for the capital and support
11    components shall be reduced by 1.7%.
12    (h) Notwithstanding any other provision of this Code, on
13and after July 1, 2012, nursing facilities designated by the
14Department of Healthcare and Family Services as "Institutions
15for Mental Disease" and "Institutions for Mental Disease" that
16are facilities licensed under the Specialized Mental Health
17Rehabilitation Act of 2013 shall have the nursing,
18socio-developmental, capital, and support components of their
19reimbursement rate effective May 1, 2011 reduced in total by
202.7%.
21    (i) On and after July 1, 2014, the reimbursement rates for
22the support component of the nursing facility rate for
23facilities licensed under the Nursing Home Care Act as skilled
24or intermediate care facilities shall be the rate in effect on
25June 30, 2014 increased by 8.17%.
26    (j) The Department may adopt rules in accordance with the

 

 

09900SB0419sam001- 22 -LRB099 03251 KTG 47095 a

1Illinois Administrative Procedure Act to implement this
2Section. However, the requirements under this Section must be
3implemented by the Department even if the Department has not
4adopted rules by the implementation date of January 1, 2017.
5(Source: P.A. 98-104, Article 6, Section 6-240, eff. 7-22-13;
698-104, Article 11, Section 11-35, eff. 7-22-13; 98-651, eff.
76-16-14; 98-727, eff. 7-16-14; 98-756, eff. 7-16-14; 99-78,
8eff. 7-20-15.)
 
9    Section 99. Effective date. This Act takes effect upon
10becoming law.".