Illinois General Assembly - Full Text of SB2433
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Full Text of SB2433  94th General Assembly

SB2433 94TH GENERAL ASSEMBLY


 


 
94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006
SB2433

 

Introduced 1/18/2006, by Sen. Don Harmon

 

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 changes in a Section concerning standards of payment of skilled nursing and intermediate care services.


LRB094 16314 DRJ 51563 b

 

 

A BILL FOR

 

SB2433 LRB094 16314 DRJ 51563 b

1     AN ACT concerning public aid.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Illinois Public Aid Code is amended by
5 changing 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
8 and Family Services Public Aid. The The Department of
9 Healthcare and Family Services Public Aid shall develop
10 standards of payment of skilled nursing and intermediate care
11 services in facilities providing such services under this
12 Article which:
13     (1) Provide for the determination of a facility's payment
14 for skilled nursing and intermediate care services on a
15 prospective basis. The amount of the payment rate for all
16 nursing facilities certified by the Department of Public Health
17 under the Nursing Home Care Act as Intermediate Care for the
18 Developmentally Disabled facilities, Long Term Care for Under
19 Age 22 facilities, Skilled Nursing facilities, or Intermediate
20 Care facilities under the medical assistance program shall be
21 prospectively established annually on the basis of historical,
22 financial, and statistical data reflecting actual costs from
23 prior years, which shall be applied to the current rate year
24 and updated for inflation, except that the capital cost element
25 for newly constructed facilities shall be based upon projected
26 budgets. The annually established payment rate shall take
27 effect on July 1 in 1984 and subsequent years. No rate increase
28 and no update for inflation shall be provided on or after July
29 1, 1994 and before July 1, 2006, unless specifically provided
30 for in this Section. The changes made by this amendatory Act of
31 the 93rd General Assembly extending the duration of the
32 prohibition against a rate increase or update for inflation are

 

 

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1 effective retroactive to July 1, 2004.
2     For facilities licensed by the Department of Public Health
3 under the Nursing Home Care Act as Intermediate Care for the
4 Developmentally Disabled facilities or Long Term Care for Under
5 Age 22 facilities, the rates taking effect on July 1, 1998
6 shall include an increase of 3%. For facilities licensed by the
7 Department of Public Health under the Nursing Home Care Act as
8 Skilled Nursing facilities or Intermediate Care facilities,
9 the rates taking effect on July 1, 1998 shall include an
10 increase of 3% plus $1.10 per resident-day, as defined by the
11 Department. For facilities licensed by the Department of Public
12 Health under the Nursing Home Care Act as Intermediate Care
13 Facilities for the Developmentally Disabled or Long Term Care
14 for Under Age 22 facilities, the rates taking effect on January
15 1, 2006 shall include an increase of 3%.
16     For facilities licensed by the Department of Public Health
17 under the Nursing Home Care Act as Intermediate Care for the
18 Developmentally Disabled facilities or Long Term Care for Under
19 Age 22 facilities, the rates taking effect on July 1, 1999
20 shall include an increase of 1.6% plus $3.00 per resident-day,
21 as defined by the Department. For facilities licensed by the
22 Department of Public Health under the Nursing Home Care Act as
23 Skilled Nursing facilities or Intermediate Care facilities,
24 the rates taking effect on July 1, 1999 shall include an
25 increase of 1.6% and, for services provided on or after October
26 1, 1999, shall be increased by $4.00 per resident-day, as
27 defined by the Department.
28     For facilities licensed by the Department of Public Health
29 under the Nursing Home Care Act as Intermediate Care for the
30 Developmentally Disabled facilities or Long Term Care for Under
31 Age 22 facilities, the rates taking effect on July 1, 2000
32 shall include an increase of 2.5% per resident-day, as defined
33 by the Department. For facilities licensed by the Department of
34 Public Health under the Nursing Home Care Act as Skilled
35 Nursing facilities or Intermediate Care facilities, the rates
36 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.
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 of Public Aid
11 shall develop the new payment methodology to meet the unique
12 needs of Illinois nursing home residents while remaining
13 subject to the appropriations provided by the General Assembly.
14 A transition period from the payment methodology in effect on
15 June 30, 2003 to the payment methodology in effect on July 1,
16 2003 shall be provided for a period not exceeding 3 years after
17 implementation of the new payment methodology as follows:
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
25     Department implements the new payment methodology until a
26     higher nursing component rate of reimbursement is achieved
27     by that facility.
28         (B) For a facility that would receive a higher nursing
29     component rate per patient day under the payment
30     methodology in effect on July 1, 2003 than the facility
31     received effective on the date immediately preceding the
32     date that the Department implements the new payment
33     methodology, the nursing component rate per patient day for
34     the facility shall be adjusted.
35         (C) Notwithstanding paragraphs (A) and (B), the
36     nursing component rate per patient day for the facility

 

 

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1     shall be adjusted subject to appropriations provided by the
2     General Assembly.
3     For facilities licensed by the Department of Public Health
4 under the Nursing Home Care Act as Intermediate Care for the
5 Developmentally Disabled facilities or Long Term Care for Under
6 Age 22 facilities, the rates taking effect on March 1, 2001
7 shall include a statewide increase of 7.85%, as defined by the
8 Department.
9     For facilities licensed by the Department of Public Health
10 under the Nursing Home Care Act as Intermediate Care for the
11 Developmentally Disabled facilities or Long Term Care for Under
12 Age 22 facilities, the rates taking effect on April 1, 2002
13 shall include a statewide increase of 2.0%, as defined by the
14 Department. This increase terminates on July 1, 2002; beginning
15 July 1, 2002 these rates are reduced to the level of the rates
16 in effect on March 31, 2002, as defined by the Department.
17     For facilities licensed by the Department of Public Health
18 under the Nursing Home Care Act as skilled nursing facilities
19 or intermediate care facilities, the rates taking effect on
20 July 1, 2001 shall be computed using the most recent cost
21 reports on file with the Department of Public Aid no later than
22 April 1, 2000, updated for inflation to January 1, 2001. For
23 rates effective July 1, 2001 only, rates shall be the greater
24 of the rate computed for July 1, 2001 or the rate effective on
25 June 30, 2001.
26     Notwithstanding any other provision of this Section, for
27 facilities licensed by the Department of Public Health under
28 the Nursing Home Care Act as skilled nursing facilities or
29 intermediate care facilities, the Illinois Department shall
30 determine by rule the rates taking effect on July 1, 2002,
31 which shall be 5.9% less than the rates in effect on June 30,
32 2002.
33     Notwithstanding any other provision of this Section, for
34 facilities licensed by the Department of Public Health under
35 the Nursing Home Care Act as skilled nursing facilities or
36 intermediate care facilities, if the payment methodologies

 

 

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1 required under Section 5A-12 and the waiver granted under 42
2 CFR 433.68 are approved by the United States Centers for
3 Medicare and Medicaid Services, the rates taking effect on July
4 1, 2004 shall be 3.0% greater than the rates in effect on June
5 30, 2004. These rates shall take effect only upon approval and
6 implementation of the payment methodologies required under
7 Section 5A-12.
8     Notwithstanding any other provisions of this Section, for
9 facilities licensed by the Department of Public Health under
10 the Nursing Home Care Act as skilled nursing facilities or
11 intermediate care facilities, the rates taking effect on
12 January 1, 2005 shall be 3% more than the rates in effect on
13 December 31, 2004.
14     For facilities licensed by the Department of Public Health
15 under the Nursing Home Care Act as Intermediate Care for the
16 Developmentally Disabled facilities or as long-term care
17 facilities for residents under 22 years of age, the rates
18 taking effect on July 1, 2003 shall include a statewide
19 increase of 4%, as defined by the Department.
20     Notwithstanding any other provision of this Section, for
21 facilities licensed by the Department of Public Health under
22 the Nursing Home Care Act as skilled nursing facilities or
23 intermediate care facilities, effective January 1, 2005,
24 facility rates shall be increased by the difference between (i)
25 a facility's per diem property, liability, and malpractice
26 insurance costs as reported in the cost report filed with the
27 Department of Public Aid and used to establish rates effective
28 July 1, 2001 and (ii) those same costs as reported in the
29 facility's 2002 cost report. These costs shall be passed
30 through to the facility without caps or limitations, except for
31 adjustments required under normal auditing procedures.
32     Rates established effective each July 1 shall govern
33 payment for services rendered throughout that fiscal year,
34 except that rates established on July 1, 1996 shall be
35 increased by 6.8% for services provided on or after January 1,
36 1997. Such rates will be based upon the rates calculated for

 

 

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1 the year beginning July 1, 1990, and for subsequent years
2 thereafter until June 30, 2001 shall be based on the facility
3 cost reports for the facility fiscal year ending at any point
4 in time during the previous calendar year, updated to the
5 midpoint of the rate year. The cost report shall be on file
6 with the Department no later than April 1 of the current rate
7 year. Should the cost report not be on file by April 1, the
8 Department shall base the rate on the latest cost report filed
9 by each skilled care facility and intermediate care facility,
10 updated to the midpoint of the current rate year. In
11 determining rates for services rendered on and after July 1,
12 1985, fixed time shall not be computed at less than zero. The
13 Department shall not make any alterations of regulations which
14 would reduce any component of the Medicaid rate to a level
15 below what that component would have been utilizing in the rate
16 effective on July 1, 1984.
17     (2) Shall take into account the actual costs incurred by
18 facilities in providing services for recipients of skilled
19 nursing and intermediate care services under the medical
20 assistance program.
21     (3) Shall take into account the medical and psycho-social
22 characteristics and needs of the patients.
23     (4) Shall take into account the actual costs incurred by
24 facilities in meeting licensing and certification standards
25 imposed and prescribed by the State of Illinois, any of its
26 political subdivisions or municipalities and by the U.S.
27 Department of Health and Human Services pursuant to Title XIX
28 of the Social Security Act.
29     The Department of Healthcare and Family Services Public Aid
30 shall develop precise standards for payments to reimburse
31 nursing facilities for any utilization of appropriate
32 rehabilitative personnel for the provision of rehabilitative
33 services which is authorized by federal regulations, including
34 reimbursement for services provided by qualified therapists or
35 qualified assistants, and which is in accordance with accepted
36 professional practices. Reimbursement also may be made for

 

 

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1 utilization of other supportive personnel under appropriate
2 supervision.
3 (Source: P.A. 93-20, eff. 6-20-03; 93-649, eff. 1-8-04; 93-659,
4 eff. 2-3-04; 93-841, eff. 7-30-04; 93-1087, eff. 2-28-05;
5 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; 94-697, eff. 11-21-05;
6 revised 12-15-05.)