Full Text of HB3125 103rd General Assembly
HB3125 103RD GENERAL ASSEMBLY |
| | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024 HB3125 Introduced 2/17/2023, by Rep. Elizabeth "Lisa" Hernandez SYNOPSIS AS INTRODUCED: |
| 305 ILCS 5/5-5.2 | from Ch. 23, par. 5-5.2 |
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Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, on and after July 1, 2023 (rather than July 1, 2014), the reimbursement rates for the support component of the nursing facility rate for facilities licensed under the Nursing Home Care Act as skilled or intermediate care facilities shall be the rate in effect on June 30, 2014 increased by 8.17%. Effective July 1, 2023.
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| | A BILL FOR |
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| 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 5-5.2 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 | 9 | | Section
5-5.1 of this Act shall receive the same rate of | 10 | | payment for similar
services.
| 11 | | (b) It shall be a matter of State policy that the Illinois | 12 | | Department
shall utilize a uniform billing cycle throughout | 13 | | the State for the
long-term care providers.
| 14 | | (c) (Blank). | 15 | | (c-1) Notwithstanding any other provisions of this Code, | 16 | | the methodologies for reimbursement of nursing services as | 17 | | provided under this Article shall no longer be applicable for | 18 | | bills payable for nursing services rendered on or after a new | 19 | | reimbursement system based on the Patient Driven Payment Model | 20 | | (PDPM) has been fully operationalized, which shall take effect | 21 | | for services provided on or after the implementation of the | 22 | | PDPM reimbursement system begins. For the purposes of this | 23 | | amendatory Act of the 102nd General Assembly, the |
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| 1 | | implementation date of the PDPM reimbursement system and all | 2 | | related provisions shall be July 1, 2022 if the following | 3 | | conditions are met: (i) the Centers for Medicare and Medicaid | 4 | | Services has approved corresponding changes in the | 5 | | reimbursement system and bed assessment; and (ii) the | 6 | | Department has filed rules to implement these changes no later | 7 | | than June 1, 2022. Failure of the Department to file rules to | 8 | | implement the changes provided in this amendatory Act of the | 9 | | 102nd General Assembly no later than June 1, 2022 shall result | 10 | | in the implementation date being delayed to October 1, 2022. | 11 | | (d) The new nursing services reimbursement methodology | 12 | | utilizing the Patient Driven Payment Model, which shall be | 13 | | referred to as the PDPM reimbursement system, taking effect | 14 | | July 1, 2022, upon federal approval by the Centers for | 15 | | Medicare and Medicaid Services, shall be based on the | 16 | | following: | 17 | | (1) The methodology shall be resident-centered, | 18 | | facility-specific, cost-based, and based on guidance from | 19 | | the Centers for Medicare and Medicaid Services. | 20 | | (2) Costs shall be annually rebased and case mix index | 21 | | quarterly updated. The nursing services methodology will | 22 | | be assigned to the Medicaid enrolled residents on record | 23 | | as of 30 days prior to the beginning of the rate period in | 24 | | the Department's Medicaid Management Information System | 25 | | (MMIS) as present on the last day of the second quarter | 26 | | preceding the rate period based upon the Assessment |
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| 1 | | Reference Date of the Minimum Data Set (MDS). | 2 | | (3) Regional wage adjustors based on the Health | 3 | | Service Areas (HSA) groupings and adjusters in effect on | 4 | | April 30, 2012 shall be included, except no adjuster shall | 5 | | be lower than 1.06. | 6 | | (4) PDPM nursing case mix indices in effect on March | 7 | | 1, 2022 shall be assigned to each resident class at no less | 8 | | than 0.7858 of the Centers for Medicare and Medicaid | 9 | | Services PDPM unadjusted case mix values, in effect on | 10 | | March 1, 2022. | 11 | | (5) The pool of funds available for distribution by | 12 | | case mix and the base facility rate shall be determined | 13 | | using the formula contained in subsection (d-1). | 14 | | (6) The Department shall establish a variable per diem | 15 | | staffing add-on in accordance with the most recent | 16 | | available federal staffing report, currently the Payroll | 17 | | Based Journal, for the same period of time, and if | 18 | | applicable adjusted for acuity using the same quarter's | 19 | | MDS. The Department shall rely on Payroll Based Journals | 20 | | provided to the Department of Public Health to make a | 21 | | determination of non-submission. If the Department is | 22 | | notified by a facility of missing or inaccurate Payroll | 23 | | Based Journal data or an incorrect calculation of | 24 | | staffing, the Department must make a correction as soon as | 25 | | the error is verified for the applicable quarter. | 26 | | Facilities with at least 70% of the staffing indicated |
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| 1 | | by the STRIVE study shall be paid a per diem add-on of $9, | 2 | | increasing by equivalent steps for each whole percentage | 3 | | point until the facilities reach a per diem of $14.88. | 4 | | Facilities with at least 80% of the staffing indicated by | 5 | | the STRIVE study shall be paid a per diem add-on of $14.88, | 6 | | increasing by equivalent steps for each whole percentage | 7 | | point until the facilities reach a per diem add-on of | 8 | | $23.80. Facilities with at least 92% of the staffing | 9 | | indicated by the STRIVE study shall be paid a per diem | 10 | | add-on of $23.80, increasing by equivalent steps for each | 11 | | whole percentage point until the facilities reach a per | 12 | | diem add-on of $29.75. Facilities with at least 100% of | 13 | | the staffing indicated by the STRIVE study shall be paid a | 14 | | per diem add-on of $29.75, increasing by equivalent steps | 15 | | for each whole percentage point until the facilities reach | 16 | | a per diem add-on of $35.70. Facilities with at least 110% | 17 | | of the staffing indicated by the STRIVE study shall be | 18 | | paid a per diem add-on of $35.70, increasing by equivalent | 19 | | steps for each whole percentage point until the facilities | 20 | | reach a per diem add-on of $38.68. Facilities with at | 21 | | least 125% or higher of the staffing indicated by the | 22 | | STRIVE study shall be paid a per diem add-on of $38.68. | 23 | | Beginning April 1, 2023, no nursing facility's variable | 24 | | staffing per diem add-on shall be reduced by more than 5% | 25 | | in 2 consecutive quarters. For the quarters beginning July | 26 | | 1, 2022 and October 1, 2022, no facility's variable per |
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| 1 | | diem staffing add-on shall be calculated at a rate lower | 2 | | than 85% of the staffing indicated by the STRIVE study. No | 3 | | facility below 70% of the staffing indicated by the STRIVE | 4 | | study shall receive a variable per diem staffing add-on | 5 | | after December 31, 2022. | 6 | | (7) For dates of services beginning July 1, 2022, the | 7 | | PDPM nursing component per diem for each nursing facility | 8 | | shall be the product of the facility's (i) statewide PDPM | 9 | | nursing base per diem rate, $92.25, adjusted for the | 10 | | facility average PDPM case mix index calculated quarterly | 11 | | and (ii) the regional wage adjuster, and then add the | 12 | | Medicaid access adjustment as defined in (e-3) of this | 13 | | Section. Transition rates for services provided between | 14 | | July 1, 2022 and October 1, 2023 shall be the greater of | 15 | | the PDPM nursing component per diem or: | 16 | | (A) for the quarter beginning July 1, 2022, the | 17 | | RUG-IV nursing component per diem; | 18 | | (B) for the quarter beginning October 1, 2022, the | 19 | | sum of the RUG-IV nursing component per diem | 20 | | multiplied by 0.80 and the PDPM nursing component per | 21 | | diem multiplied by 0.20; | 22 | | (C) for the quarter beginning January 1, 2023, the | 23 | | sum of the RUG-IV nursing component per diem | 24 | | multiplied by 0.60 and the PDPM nursing component per | 25 | | diem multiplied by 0.40; | 26 | | (D) for the quarter beginning April 1, 2023, the |
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| 1 | | sum of the RUG-IV nursing component per diem | 2 | | multiplied by 0.40 and the PDPM nursing component per | 3 | | diem multiplied by 0.60; | 4 | | (E) for the quarter beginning July 1, 2023, the | 5 | | sum of the RUG-IV nursing component per diem | 6 | | multiplied by 0.20 and the PDPM nursing component per | 7 | | diem multiplied by 0.80; or | 8 | | (F) for the quarter beginning October 1, 2023 and | 9 | | each subsequent quarter, the transition rate shall end | 10 | | and a nursing facility shall be paid 100% of the PDPM | 11 | | nursing component per diem. | 12 | | (d-1) Calculation of base year Statewide RUG-IV nursing | 13 | | base per diem rate. | 14 | | (1) Base rate spending pool shall be: | 15 | | (A) The base year resident days which are | 16 | | calculated by multiplying the number of Medicaid | 17 | | residents in each nursing home as indicated in the MDS | 18 | | data defined in paragraph (4) by 365. | 19 | | (B) Each facility's nursing component per diem in | 20 | | effect on July 1, 2012 shall be multiplied by | 21 | | subsection (A). | 22 | | (C) Thirteen million is added to the product of | 23 | | subparagraph (A) and subparagraph (B) to adjust for | 24 | | the exclusion of nursing homes defined in paragraph | 25 | | (5). | 26 | | (2) For each nursing home with Medicaid residents as |
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| 1 | | indicated by the MDS data defined in paragraph (4), | 2 | | weighted days adjusted for case mix and regional wage | 3 | | adjustment shall be calculated. For each home this | 4 | | calculation is the product of: | 5 | | (A) Base year resident days as calculated in | 6 | | subparagraph (A) of paragraph (1). | 7 | | (B) The nursing home's regional wage adjustor | 8 | | based on the Health Service Areas (HSA) groupings and | 9 | | adjustors in effect on April 30, 2012. | 10 | | (C) Facility weighted case mix which is the number | 11 | | of Medicaid residents as indicated by the MDS data | 12 | | defined in paragraph (4) multiplied by the associated | 13 | | case weight for the RUG-IV 48 grouper model using | 14 | | standard RUG-IV procedures for index maximization. | 15 | | (D) The sum of the products calculated for each | 16 | | nursing home in subparagraphs (A) through (C) above | 17 | | shall be the base year case mix, rate adjusted | 18 | | weighted days. | 19 | | (3) The Statewide RUG-IV nursing base per diem rate: | 20 | | (A) on January 1, 2014 shall be the quotient of the | 21 | | paragraph (1) divided by the sum calculated under | 22 | | subparagraph (D) of paragraph (2); | 23 | | (B) on and after July 1, 2014 and until July 1, | 24 | | 2022, shall be the amount calculated under | 25 | | subparagraph (A) of this paragraph (3) plus $1.76; and | 26 | | (C) beginning July 1, 2022 and thereafter, $7 |
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| 1 | | shall be added to the amount calculated under | 2 | | subparagraph (B) of this paragraph (3) of this | 3 | | Section. | 4 | | (4) Minimum Data Set (MDS) comprehensive assessments | 5 | | for Medicaid residents on the last day of the quarter used | 6 | | to establish the base rate. | 7 | | (5) Nursing facilities designated as of July 1, 2012 | 8 | | by the Department as "Institutions for Mental Disease" | 9 | | shall be excluded from all calculations under this | 10 | | subsection. The data from these facilities shall not be | 11 | | used in the computations described in paragraphs (1) | 12 | | through (4) above to establish the base rate. | 13 | | (e) Beginning July 1, 2014, the Department shall allocate | 14 | | funding in the amount up to $10,000,000 for per diem add-ons to | 15 | | the RUGS methodology for dates of service on and after July 1, | 16 | | 2014: | 17 | | (1) $0.63 for each resident who scores in I4200 | 18 | | Alzheimer's Disease or I4800 non-Alzheimer's Dementia. | 19 | | (2) $2.67 for each resident who scores either a "1" or | 20 | | "2" in any items S1200A through S1200I and also scores in | 21 | | RUG groups PA1, PA2, BA1, or BA2. | 22 | | (e-1) (Blank). | 23 | | (e-2) For dates of services beginning January 1, 2014 and | 24 | | ending September 30, 2023, the RUG-IV nursing component per | 25 | | diem for a nursing home shall be the product of the statewide | 26 | | RUG-IV nursing base per diem rate, the facility average case |
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| 1 | | mix index, and the regional wage adjustor. For dates of | 2 | | service beginning July 1, 2022 and ending September 30, 2023, | 3 | | the Medicaid access adjustment described in subsection (e-3) | 4 | | shall be added to the product. | 5 | | (e-3) A Medicaid Access Adjustment of $4 adjusted for the | 6 | | facility average PDPM case mix index calculated quarterly | 7 | | shall be added to the statewide PDPM nursing per diem for all | 8 | | facilities with annual Medicaid bed days of at least 70% of all | 9 | | occupied bed days adjusted quarterly. For each new calendar | 10 | | year and for the 6-month period beginning July 1, 2022, the | 11 | | percentage of a facility's occupied bed days comprised of | 12 | | Medicaid bed days shall be determined by the Department | 13 | | quarterly. For dates of service beginning January 1, 2023, the | 14 | | Medicaid Access Adjustment shall be increased to $4.75. This | 15 | | subsection shall be inoperative on and after January 1, 2028. | 16 | | (f) (Blank). | 17 | | (g) Notwithstanding any other provision of this Code, on | 18 | | and after July 1, 2012, for facilities not designated by the | 19 | | Department of Healthcare and Family Services as "Institutions | 20 | | for Mental Disease", rates effective May 1, 2011 shall be | 21 | | adjusted as follows: | 22 | | (1) (Blank); | 23 | | (2) (Blank); | 24 | | (3) Facility rates for the capital and support | 25 | | components shall be reduced by 1.7%. | 26 | | (h) Notwithstanding any other provision of this Code, on |
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| 1 | | and after July 1, 2012, nursing facilities designated by the | 2 | | Department of Healthcare and Family Services as "Institutions | 3 | | for Mental Disease" and "Institutions for Mental Disease" that | 4 | | are facilities licensed under the Specialized Mental Health | 5 | | Rehabilitation Act of 2013 shall have the nursing, | 6 | | socio-developmental, capital, and support components of their | 7 | | reimbursement rate effective May 1, 2011 reduced in total by | 8 | | 2.7%. | 9 | | (i) On and after July 1, 2023 2014 , the reimbursement | 10 | | rates for the support component of the nursing facility rate | 11 | | for facilities licensed under the Nursing Home Care Act as | 12 | | skilled or intermediate care facilities shall be the rate in | 13 | | effect on June 30, 2014 increased by 8.17%. | 14 | | (j) Notwithstanding any other provision of law, subject to | 15 | | federal approval, effective July 1, 2019, sufficient funds | 16 | | shall be allocated for changes to rates for facilities | 17 | | licensed under the Nursing Home Care Act as skilled nursing | 18 | | facilities or intermediate care facilities for dates of | 19 | | services on and after July 1, 2019: (i) to establish, through | 20 | | June 30, 2022 a per diem add-on to the direct care per diem | 21 | | rate not to exceed $70,000,000 annually in the aggregate | 22 | | taking into account federal matching funds for the purpose of | 23 | | addressing the facility's unique staffing needs, adjusted | 24 | | quarterly and distributed by a weighted formula based on | 25 | | Medicaid bed days on the last day of the second quarter | 26 | | preceding the quarter for which the rate is being adjusted. |
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| 1 | | Beginning July 1, 2022, the annual $70,000,000 described in | 2 | | the preceding sentence shall be dedicated to the variable per | 3 | | diem add-on for staffing under paragraph (6) of subsection | 4 | | (d); and (ii) in an amount not to exceed $170,000,000 annually | 5 | | in the aggregate taking into account federal matching funds to | 6 | | permit the support component of the nursing facility rate to | 7 | | be updated as follows: | 8 | | (1) 80%, or $136,000,000, of the funds shall be used | 9 | | to update each facility's rate in effect on June 30, 2019 | 10 | | using the most recent cost reports on file, which have had | 11 | | a limited review conducted by the Department of Healthcare | 12 | | and Family Services and will not hold up enacting the rate | 13 | | increase, with the Department of Healthcare and Family | 14 | | Services. | 15 | | (2) After completing the calculation in paragraph (1), | 16 | | any facility whose rate is less than the rate in effect on | 17 | | June 30, 2019 shall have its rate restored to the rate in | 18 | | effect on June 30, 2019 from the 20% of the funds set | 19 | | aside. | 20 | | (3) The remainder of the 20%, or $34,000,000, shall be | 21 | | used to increase each facility's rate by an equal | 22 | | percentage. | 23 | | (k) During the first quarter of State Fiscal Year 2020, | 24 | | the Department of Healthcare of Family Services must convene a | 25 | | technical advisory group consisting of members of all trade | 26 | | associations representing Illinois skilled nursing providers |
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| 1 | | to discuss changes necessary with federal implementation of | 2 | | Medicare's Patient-Driven Payment Model. Implementation of | 3 | | Medicare's Patient-Driven Payment Model shall, by September 1, | 4 | | 2020, end the collection of the MDS data that is necessary to | 5 | | maintain the current RUG-IV Medicaid payment methodology. The | 6 | | technical advisory group must consider a revised reimbursement | 7 | | methodology that takes into account transparency, | 8 | | accountability, actual staffing as reported under the | 9 | | federally required Payroll Based Journal system, changes to | 10 | | the minimum wage, adequacy in coverage of the cost of care, and | 11 | | a quality component that rewards quality improvements. | 12 | | (l) The Department shall establish per diem add-on | 13 | | payments to improve the quality of care delivered by | 14 | | facilities, including: | 15 | | (1) Incentive payments determined by facility | 16 | | performance on specified quality measures in an initial | 17 | | amount of $70,000,000. Nothing in this subsection shall be | 18 | | construed to limit the quality of care payments in the | 19 | | aggregate statewide to $70,000,000, and, if quality of | 20 | | care has improved across nursing facilities, the | 21 | | Department shall adjust those add-on payments accordingly. | 22 | | The quality payment methodology described in this | 23 | | subsection must be used for at least State Fiscal Year | 24 | | 2023. Beginning with the quarter starting July 1, 2023, | 25 | | the Department may add, remove, or change quality metrics | 26 | | and make associated changes to the quality payment |
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| 1 | | methodology as outlined in subparagraph (E). Facilities | 2 | | designated by the Centers for Medicare and Medicaid | 3 | | Services as a special focus facility or a hospital-based | 4 | | nursing home do not qualify for quality payments. | 5 | | (A) Each quality pool must be distributed by | 6 | | assigning a quality weighted score for each nursing | 7 | | home which is calculated by multiplying the nursing | 8 | | home's quality base period Medicaid days by the | 9 | | nursing home's star rating weight in that period. | 10 | | (B) Star rating weights are assigned based on the
| 11 | | nursing home's star rating for the LTS quality star
| 12 | | rating. As used in this subparagraph, "LTS quality
| 13 | | star rating" means the long-term stay quality rating | 14 | | for
each nursing facility, as assigned by the Centers | 15 | | for
Medicare and Medicaid Services under the Five-Star
| 16 | | Quality Rating System. The rating is a number ranging
| 17 | | from 0 (lowest) to 5 (highest). | 18 | | (i) Zero-star or one-star rating has a weight | 19 | | of 0. | 20 | | (ii) Two-star rating has a weight of 0.75. | 21 | | (iii) Three-star rating has a weight of 1.5. | 22 | | (iv) Four-star rating has a weight of 2.5. | 23 | | (v) Five-star rating has a weight of 3.5. | 24 | | (C) Each nursing home's quality weight score is | 25 | | divided by the sum of all quality weight scores for | 26 | | qualifying nursing homes to determine the proportion |
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| 1 | | of the quality pool to be paid to the nursing home. | 2 | | (D) The quality pool is no less than $70,000,000 | 3 | | annually or $17,500,000 per quarter. The Department | 4 | | shall publish on its website the estimated payments | 5 | | and the associated weights for each facility 45 days | 6 | | prior to when the initial payments for the quarter are | 7 | | to be paid. The Department shall assign each facility | 8 | | the most recent and applicable quarter's STAR value | 9 | | unless the facility notifies the Department within 15 | 10 | | days of an issue and the facility provides reasonable | 11 | | evidence demonstrating its timely compliance with | 12 | | federal data submission requirements for the quarter | 13 | | of record. If such evidence cannot be provided to the | 14 | | Department, the STAR rating assigned to the facility | 15 | | shall be reduced by one from the prior quarter. | 16 | | (E) The Department shall review quality metrics | 17 | | used for payment of the quality pool and make | 18 | | recommendations for any associated changes to the | 19 | | methodology for distributing quality pool payments in | 20 | | consultation with associations representing long-term | 21 | | care providers, consumer advocates, organizations | 22 | | representing workers of long-term care facilities, and | 23 | | payors. The Department may establish, by rule, changes | 24 | | to the methodology for distributing quality pool | 25 | | payments. | 26 | | (F) The Department shall disburse quality pool |
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| 1 | | payments from the Long-Term Care Provider Fund on a | 2 | | monthly basis in amounts proportional to the total | 3 | | quality pool payment determined for the quarter. | 4 | | (G) The Department shall publish any changes in | 5 | | the methodology for distributing quality pool payments | 6 | | prior to the beginning of the measurement period or | 7 | | quality base period for any metric added to the | 8 | | distribution's methodology. | 9 | | (2) Payments based on CNA tenure, promotion, and CNA | 10 | | training for the purpose of increasing CNA compensation. | 11 | | It is the intent of this subsection that payments made in | 12 | | accordance with this paragraph be directly incorporated | 13 | | into increased compensation for CNAs. As used in this | 14 | | paragraph, "CNA" means a certified nursing assistant as | 15 | | that term is described in Section 3-206 of the Nursing | 16 | | Home Care Act, Section 3-206 of the ID/DD Community Care | 17 | | Act, and Section 3-206 of the MC/DD Act. The Department | 18 | | shall establish, by rule, payments to nursing facilities | 19 | | equal to Medicaid's share of the tenure wage increments | 20 | | specified in this paragraph for all reported CNA employee | 21 | | hours compensated according to a posted schedule | 22 | | consisting of increments at least as large as those | 23 | | specified in this paragraph. The increments are as | 24 | | follows: an additional $1.50 per hour for CNAs with at | 25 | | least one and less than 2 years' experience plus another | 26 | | $1 per hour for each additional year of experience up to a |
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| 1 | | maximum of $6.50 for CNAs with at least 6 years of | 2 | | experience. For purposes of this paragraph, Medicaid's | 3 | | share shall be the ratio determined by paid Medicaid bed | 4 | | days divided by total bed days for the applicable time | 5 | | period used in the calculation. In addition, and additive | 6 | | to any tenure increments paid as specified in this | 7 | | paragraph, the Department shall establish, by rule, | 8 | | payments supporting Medicaid's share of the | 9 | | promotion-based wage increments for CNA employee hours | 10 | | compensated for that promotion with at least a $1.50 | 11 | | hourly increase. Medicaid's share shall be established as | 12 | | it is for the tenure increments described in this | 13 | | paragraph. Qualifying promotions shall be defined by the | 14 | | Department in rules for an expected 10-15% subset of CNAs | 15 | | assigned intermediate, specialized, or added roles such as | 16 | | CNA trainers, CNA scheduling "captains", and CNA | 17 | | specialists for resident conditions like dementia or | 18 | | memory care or behavioral health. | 19 | | (m) The Department shall work with nursing facility | 20 | | industry representatives to design policies and procedures to | 21 | | permit facilities to address the integrity of data from | 22 | | federal reporting sites used by the Department in setting | 23 | | facility rates. | 24 | | (Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19; | 25 | | 102-77, eff. 7-9-21; 102-558, eff. 8-20-21; 102-1035, eff. | 26 | | 5-31-22; 102-1118, eff. 1-18-23.)
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| 1 | | Section 99. Effective date. This Act takes effect July 1, | 2 | | 2023.
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