Illinois General Assembly - Full Text of SB0110
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Full Text of SB0110  102nd General Assembly




SB0110 EnrolledLRB102 11332 KTG 16665 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 5-5.2 as follows:
6    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
7    Sec. 5-5.2. Payment.
8    (a) All nursing facilities that are grouped pursuant to
9Section 5-5.1 of this Act shall receive the same rate of
10payment for similar services.
11    (b) It shall be a matter of State policy that the Illinois
12Department shall utilize a uniform billing cycle throughout
13the State for the long-term care providers.
14    (c) Notwithstanding any other provisions of this Code, the
15methodologies for reimbursement of nursing services as
16provided under this Article shall no longer be applicable for
17bills payable for nursing services rendered on or after a new
18reimbursement system based on the Resource Utilization Groups
19(RUGs) has been fully operationalized, which shall take effect
20for services provided on or after January 1, 2014.
21    (d) The new nursing services reimbursement methodology
22utilizing RUG-IV 48 grouper model, which shall be referred to
23as the RUGs reimbursement system, taking effect January 1,



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12014, shall be based on the following:
2        (1) The methodology shall be resident-driven,
3    facility-specific, and cost-based.
4        (2) Costs shall be annually rebased and case mix index
5    quarterly updated. The nursing services methodology will
6    be assigned to the Medicaid enrolled residents on record
7    as of 30 days prior to the beginning of the rate period in
8    the Department's Medicaid Management Information System
9    (MMIS) as present on the last day of the second quarter
10    preceding the rate period based upon the Assessment
11    Reference Date of the Minimum Data Set (MDS).
12        (3) Regional wage adjustors based on the Health
13    Service Areas (HSA) groupings and adjusters in effect on
14    April 30, 2012 shall be included, except no adjuster shall
15    be lower than 1.0.
16        (4) Case mix index shall be assigned to each resident
17    class based on the Centers for Medicare and Medicaid
18    Services staff time measurement study in effect on July 1,
19    2013, utilizing an index maximization approach.
20        (5) The pool of funds available for distribution by
21    case mix and the base facility rate shall be determined
22    using the formula contained in subsection (d-1).
23    (d-1) Calculation of base year Statewide RUG-IV nursing
24base per diem rate.
25        (1) Base rate spending pool shall be:
26            (A) The base year resident days which are



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1        calculated by multiplying the number of Medicaid
2        residents in each nursing home as indicated in the MDS
3        data defined in paragraph (4) by 365.
4            (B) Each facility's nursing component per diem in
5        effect on July 1, 2012 shall be multiplied by
6        subsection (A).
7            (C) Thirteen million is added to the product of
8        subparagraph (A) and subparagraph (B) to adjust for
9        the exclusion of nursing homes defined in paragraph
10        (5).
11        (2) For each nursing home with Medicaid residents as
12    indicated by the MDS data defined in paragraph (4),
13    weighted days adjusted for case mix and regional wage
14    adjustment shall be calculated. For each home this
15    calculation is the product of:
16            (A) Base year resident days as calculated in
17        subparagraph (A) of paragraph (1).
18            (B) The nursing home's regional wage adjustor
19        based on the Health Service Areas (HSA) groupings and
20        adjustors in effect on April 30, 2012.
21            (C) Facility weighted case mix which is the number
22        of Medicaid residents as indicated by the MDS data
23        defined in paragraph (4) multiplied by the associated
24        case weight for the RUG-IV 48 grouper model using
25        standard RUG-IV procedures for index maximization.
26            (D) The sum of the products calculated for each



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1        nursing home in subparagraphs (A) through (C) above
2        shall be the base year case mix, rate adjusted
3        weighted days.
4        (3) The Statewide RUG-IV nursing base per diem rate:
5            (A) on January 1, 2014 shall be the quotient of the
6        paragraph (1) divided by the sum calculated under
7        subparagraph (D) of paragraph (2); and
8            (B) on and after July 1, 2014, shall be the amount
9        calculated under subparagraph (A) of this paragraph
10        (3) plus $1.76.
11        (4) Minimum Data Set (MDS) comprehensive assessments
12    for Medicaid residents on the last day of the quarter used
13    to establish the base rate.
14        (5) Nursing facilities designated as of July 1, 2012
15    by the Department as "Institutions for Mental Disease"
16    shall be excluded from all calculations under this
17    subsection. The data from these facilities shall not be
18    used in the computations described in paragraphs (1)
19    through (4) above to establish the base rate.
20    (e) Beginning July 1, 2014, the Department shall allocate
21funding in the amount up to $10,000,000 for per diem add-ons to
22the RUGS methodology for dates of service on and after July 1,
24        (1) $0.63 for each resident who scores in I4200
25    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
26        (2) $2.67 for each resident who scores either a "1" or



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



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1        per diem calculated for the current quarter minus the
2        nursing component rate in effect July 1, 2012
3        multiplied by 0.13.
4    (f) Notwithstanding any other provision of this Code, on
5and after July 1, 2012, reimbursement rates associated with
6the nursing or support components of the current nursing
7facility rate methodology shall not increase beyond the level
8effective May 1, 2011 until a new reimbursement system based
9on the RUGs IV 48 grouper model has been fully
11    (g) Notwithstanding any other provision of this Code, on
12and after July 1, 2012, for facilities not designated by the
13Department of Healthcare and Family Services as "Institutions
14for Mental Disease", rates effective May 1, 2011 shall be
15adjusted as follows:
16        (1) Individual nursing rates for residents classified
17    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
18    ending March 31, 2012 shall be reduced by 10%;
19        (2) Individual nursing rates for residents classified
20    in all other RUG IV groups shall be reduced by 1.0%;
21        (3) Facility rates for the capital and support
22    components shall be reduced by 1.7%.
23    (h) Notwithstanding any other provision of this Code, on
24and after July 1, 2012, nursing facilities designated by the
25Department of Healthcare and Family Services as "Institutions
26for Mental Disease" and "Institutions for Mental Disease" that



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1are facilities licensed under the Specialized Mental Health
2Rehabilitation Act of 2013 shall have the nursing,
3socio-developmental, capital, and support components of their
4reimbursement rate effective May 1, 2011 reduced in total by
6    (i) On and after July 1, 2014, the reimbursement rates for
7the support component of the nursing facility rate for
8facilities licensed under the Nursing Home Care Act as skilled
9or intermediate care facilities shall be the rate in effect on
10June 30, 2014 increased by 8.17%.
11    (j) Notwithstanding any other provision of law, subject to
12federal approval, effective July 1, 2019, sufficient funds
13shall be allocated for changes to rates for facilities
14licensed under the Nursing Home Care Act as skilled nursing
15facilities or intermediate care facilities for dates of
16services on and after July 1, 2019: (i) to establish a per diem
17add-on to the direct care per diem rate not to exceed
18$70,000,000 annually in the aggregate taking into account
19federal matching funds for the purpose of addressing the
20facility's unique staffing needs, adjusted quarterly and
21distributed by a weighted formula based on Medicaid bed days
22on the last day of the second quarter preceding the quarter for
23which the rate is being adjusted; and (ii) in an amount not to
24exceed $170,000,000 annually in the aggregate taking into
25account federal matching funds to permit the support component
26of the nursing facility rate to be updated as follows:



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1        (1) 80%, or $136,000,000, of the funds shall be used
2    to update each facility's rate in effect on June 30, 2019
3    using the most recent cost reports on file, which have had
4    a limited review conducted by the Department of Healthcare
5    and Family Services and will not hold up enacting the rate
6    increase, with the Department of Healthcare and Family
7    Services and taking into account subsection (i).
8        (2) After completing the calculation in paragraph (1),
9    any facility whose rate is less than the rate in effect on
10    June 30, 2019 shall have its rate restored to the rate in
11    effect on June 30, 2019 from the 20% of the funds set
12    aside.
13        (3) The remainder of the 20%, or $34,000,000, shall be
14    used to increase each facility's rate by an equal
15    percentage.
16    To implement item (i) in this subsection, facilities shall
17file quarterly reports documenting compliance with its
18annually approved staffing plan, which shall permit compliance
19with Section 3-202.05 of the Nursing Home Care Act. A facility
20that fails to meet the benchmarks and dates contained in the
21plan may have its add-on adjusted in the quarter following the
22quarterly review. Nothing in this Section shall limit the
23ability of the facility to appeal a ruling of non-compliance
24and a subsequent reduction to the add-on. Funds adjusted for
25noncompliance shall be maintained in the Long-Term Care
26Provider Fund and accounted for separately. At the end of each



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1fiscal year, these funds shall be made available to facilities
2for special staffing projects.
3    In order to provide for the expeditious and timely
4implementation of the provisions of Public Act 101-10 this
5amendatory Act of the 101st General Assembly, emergency rules
6to implement any provision of Public Act 101-10 this
7amendatory Act of the 101st General Assembly may be adopted in
8accordance with this subsection by the agency charged with
9administering that provision or initiative. The agency shall
10simultaneously file emergency rules and permanent rules to
11ensure that there is no interruption in administrative
12guidance. The 150-day limitation of the effective period of
13emergency rules does not apply to rules adopted under this
14subsection, and the effective period may continue through June
1530, 2021. The 24-month limitation on the adoption of emergency
16rules does not apply to rules adopted under this subsection.
17The adoption of emergency rules authorized by this subsection
18is deemed to be necessary for the public interest, safety, and
20    (k) (j) During the first quarter of State Fiscal Year
212020, the Department of Healthcare of Family Services must
22convene a technical advisory group consisting of members of
23all trade associations representing Illinois skilled nursing
24providers to discuss changes necessary with federal
25implementation of Medicare's Patient-Driven Payment Model.
26Implementation of Medicare's Patient-Driven Payment Model



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1shall, by September 1, 2020, end the collection of the MDS data
2that is necessary to maintain the current RUG-IV Medicaid
3payment methodology. The technical advisory group must
4consider a revised reimbursement methodology that takes into
5account transparency, accountability, actual staffing as
6reported under the federally required Payroll Based Journal
7system, changes to the minimum wage, adequacy in coverage of
8the cost of care, and a quality component that rewards quality
10(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
11revised 9-18-19.)
12    Section 99. Effective date. This Act takes effect upon
13becoming law.