Full Text of SB1580 95th General Assembly
SB1580enr 95TH GENERAL ASSEMBLY
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| AN ACT concerning public health.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 1. Short title. This Act may be cited as the FY2008 | 5 |
| Budget
Implementation (Human Services) Act. | 6 |
| Section 5. Purpose. It is the purpose of this Act to | 7 |
| implement the Governor's FY2008
budget recommendations | 8 |
| concerning human services.
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| Section 10. The Illinois Administrative Procedure Act is | 10 |
| amended by changing Section 5-45 as follows:
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| (5 ILCS 100/5-45) (from Ch. 127, par. 1005-45)
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| Sec. 5-45. Emergency rulemaking.
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| (a) "Emergency" means the existence of any situation that | 14 |
| any agency
finds reasonably constitutes a threat to the public | 15 |
| interest, safety, or
welfare.
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| (b) If any agency finds that an
emergency exists that | 17 |
| requires adoption of a rule upon fewer days than
is required by | 18 |
| Section 5-40 and states in writing its reasons for that
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| finding, the agency may adopt an emergency rule without prior | 20 |
| notice or
hearing upon filing a notice of emergency rulemaking | 21 |
| with the Secretary of
State under Section 5-70. The notice |
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| shall include the text of the
emergency rule and shall be | 2 |
| published in the Illinois Register. Consent
orders or other | 3 |
| court orders adopting settlements negotiated by an agency
may | 4 |
| be adopted under this Section. Subject to applicable | 5 |
| constitutional or
statutory provisions, an emergency rule | 6 |
| becomes effective immediately upon
filing under Section 5-65 or | 7 |
| at a stated date less than 10 days
thereafter. The agency's | 8 |
| finding and a statement of the specific reasons
for the finding | 9 |
| shall be filed with the rule. The agency shall take
reasonable | 10 |
| and appropriate measures to make emergency rules known to the
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| persons who may be affected by them.
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| (c) An emergency rule may be effective for a period of not | 13 |
| longer than
150 days, but the agency's authority to adopt an | 14 |
| identical rule under Section
5-40 is not precluded. No | 15 |
| emergency rule may be adopted more
than once in any 24 month | 16 |
| period, except that this limitation on the number
of emergency | 17 |
| rules that may be adopted in a 24 month period does not apply
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| to (i) emergency rules that make additions to and deletions | 19 |
| from the Drug
Manual under Section 5-5.16 of the Illinois | 20 |
| Public Aid Code or the
generic drug formulary under Section | 21 |
| 3.14 of the Illinois Food, Drug
and Cosmetic Act, (ii) | 22 |
| emergency rules adopted by the Pollution Control
Board before | 23 |
| July 1, 1997 to implement portions of the Livestock Management
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| Facilities Act, or (iii) emergency rules adopted by the | 25 |
| Illinois Department of Public Health under subsections (a) | 26 |
| through (i) of Section 2 of the Department of Public Health Act |
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| when necessary to protect the public's health. Two or more | 2 |
| emergency rules having substantially the same
purpose and | 3 |
| effect shall be deemed to be a single rule for purposes of this
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| Section.
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| (d) In order to provide for the expeditious and timely | 6 |
| implementation
of the State's fiscal year 1999 budget, | 7 |
| emergency rules to implement any
provision of Public Act 90-587 | 8 |
| or 90-588
or any other budget initiative for fiscal year 1999 | 9 |
| may be adopted in
accordance with this Section by the agency | 10 |
| charged with administering that
provision or initiative, | 11 |
| except that the 24-month limitation on the adoption
of | 12 |
| emergency rules and the provisions of Sections 5-115 and 5-125 | 13 |
| do not apply
to rules adopted under this subsection (d). The | 14 |
| adoption of emergency rules
authorized by this subsection (d) | 15 |
| shall be deemed to be necessary for the
public interest, | 16 |
| safety, and welfare.
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| (e) In order to provide for the expeditious and timely | 18 |
| implementation
of the State's fiscal year 2000 budget, | 19 |
| emergency rules to implement any
provision of this amendatory | 20 |
| Act of the 91st General Assembly
or any other budget initiative | 21 |
| for fiscal year 2000 may be adopted in
accordance with this | 22 |
| Section by the agency charged with administering that
provision | 23 |
| or initiative, except that the 24-month limitation on the | 24 |
| adoption
of emergency rules and the provisions of Sections | 25 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 26 |
| subsection (e). The adoption of emergency rules
authorized by |
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| this subsection (e) shall be deemed to be necessary for the
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| public interest, safety, and welfare.
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| (f) In order to provide for the expeditious and timely | 4 |
| implementation
of the State's fiscal year 2001 budget, | 5 |
| emergency rules to implement any
provision of this amendatory | 6 |
| Act of the 91st General Assembly
or any other budget initiative | 7 |
| for fiscal year 2001 may be adopted in
accordance with this | 8 |
| Section by the agency charged with administering that
provision | 9 |
| or initiative, except that the 24-month limitation on the | 10 |
| adoption
of emergency rules and the provisions of Sections | 11 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 12 |
| subsection (f). The adoption of emergency rules
authorized by | 13 |
| this subsection (f) shall be deemed to be necessary for the
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| public interest, safety, and welfare.
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| (g) In order to provide for the expeditious and timely | 16 |
| implementation
of the State's fiscal year 2002 budget, | 17 |
| emergency rules to implement any
provision of this amendatory | 18 |
| Act of the 92nd General Assembly
or any other budget initiative | 19 |
| for fiscal year 2002 may be adopted in
accordance with this | 20 |
| Section by the agency charged with administering that
provision | 21 |
| or initiative, except that the 24-month limitation on the | 22 |
| adoption
of emergency rules and the provisions of Sections | 23 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 24 |
| subsection (g). The adoption of emergency rules
authorized by | 25 |
| this subsection (g) shall be deemed to be necessary for the
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| public interest, safety, and welfare.
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| (h) In order to provide for the expeditious and timely | 2 |
| implementation
of the State's fiscal year 2003 budget, | 3 |
| emergency rules to implement any
provision of this amendatory | 4 |
| Act of the 92nd General Assembly
or any other budget initiative | 5 |
| for fiscal year 2003 may be adopted in
accordance with this | 6 |
| Section by the agency charged with administering that
provision | 7 |
| or initiative, except that the 24-month limitation on the | 8 |
| adoption
of emergency rules and the provisions of Sections | 9 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 10 |
| subsection (h). The adoption of emergency rules
authorized by | 11 |
| this subsection (h) shall be deemed to be necessary for the
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| public interest, safety, and welfare.
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| (i) In order to provide for the expeditious and timely | 14 |
| implementation
of the State's fiscal year 2004 budget, | 15 |
| emergency rules to implement any
provision of this amendatory | 16 |
| Act of the 93rd General Assembly
or any other budget initiative | 17 |
| for fiscal year 2004 may be adopted in
accordance with this | 18 |
| Section by the agency charged with administering that
provision | 19 |
| or initiative, except that the 24-month limitation on the | 20 |
| adoption
of emergency rules and the provisions of Sections | 21 |
| 5-115 and 5-125 do not apply
to rules adopted under this | 22 |
| subsection (i). The adoption of emergency rules
authorized by | 23 |
| this subsection (i) shall be deemed to be necessary for the
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| public interest, safety, and welfare.
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| (j) In order to provide for the expeditious and timely | 26 |
| implementation of the provisions of the State's fiscal year |
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| 2005 budget as provided under the Fiscal Year 2005 Budget | 2 |
| Implementation (Human Services) Act, emergency rules to | 3 |
| implement any provision of the Fiscal Year 2005 Budget | 4 |
| Implementation (Human Services) Act may be adopted in | 5 |
| accordance with this Section by the agency charged with | 6 |
| administering that provision, except that the 24-month | 7 |
| limitation on the adoption of emergency rules and the | 8 |
| provisions of Sections 5-115 and 5-125 do not apply to rules | 9 |
| adopted under this subsection (j). The Department of Public Aid | 10 |
| may also adopt rules under this subsection (j) necessary to | 11 |
| administer the Illinois Public Aid Code and the Children's | 12 |
| Health Insurance Program Act. The adoption of emergency rules | 13 |
| authorized by this subsection (j) shall be deemed to be | 14 |
| necessary for the public interest, safety, and welfare.
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| (k) In order to provide for the expeditious and timely | 16 |
| implementation of the provisions of the State's fiscal year | 17 |
| 2006 budget, emergency rules to implement any provision of this | 18 |
| amendatory Act of the 94th General Assembly or any other budget | 19 |
| initiative for fiscal year 2006 may be adopted in accordance | 20 |
| with this Section by the agency charged with administering that | 21 |
| provision or initiative, except that the 24-month limitation on | 22 |
| the adoption of emergency rules and the provisions of Sections | 23 |
| 5-115 and 5-125 do not apply to rules adopted under this | 24 |
| subsection (k). The Department of Healthcare and Family | 25 |
| Services may also adopt rules under this subsection (k) | 26 |
| necessary to administer the Illinois Public Aid Code, the |
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| Senior Citizens and Disabled Persons Property Tax Relief and | 2 |
| Pharmaceutical Assistance Act, the Senior Citizens and | 3 |
| Disabled Persons Prescription Drug Discount Program Act (now | 4 |
| the Illinois Prescription Drug Discount Program Act) , and the | 5 |
| Children's Health Insurance Program Act. The adoption of | 6 |
| emergency rules authorized by this subsection (k) shall be | 7 |
| deemed to be necessary for the public interest, safety, and | 8 |
| welfare.
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| (l) In order to provide for the expeditious and timely | 10 |
| implementation of the provisions of the
State's fiscal year | 11 |
| 2007 budget, the Department of Healthcare and Family Services | 12 |
| may adopt emergency rules during fiscal year 2007, including | 13 |
| rules effective July 1, 2007, in
accordance with this | 14 |
| subsection to the extent necessary to administer the | 15 |
| Department's responsibilities with respect to amendments to | 16 |
| the State plans and Illinois waivers approved by the federal | 17 |
| Centers for Medicare and Medicaid Services necessitated by the | 18 |
| requirements of Title XIX and Title XXI of the federal Social | 19 |
| Security Act. The adoption of emergency rules
authorized by | 20 |
| this subsection (l) shall be deemed to be necessary for the | 21 |
| public interest,
safety, and welfare.
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| (m) In order to provide for the expeditious and timely | 23 |
| implementation of the provisions of the
State's fiscal year | 24 |
| 2008 budget, the Department of Healthcare and Family Services | 25 |
| may adopt emergency rules during fiscal year 2008, including | 26 |
| rules effective July 1, 2008, in
accordance with this |
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| subsection to the extent necessary to administer the | 2 |
| Department's responsibilities with respect to amendments to | 3 |
| the State plans and Illinois waivers approved by the federal | 4 |
| Centers for Medicare and Medicaid Services necessitated by the | 5 |
| requirements of Title XIX and Title XXI of the federal Social | 6 |
| Security Act. The adoption of emergency rules
authorized by | 7 |
| this subsection (m) shall be deemed to be necessary for the | 8 |
| public interest,
safety, and welfare.
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| (Source: P.A. 93-20, eff. 6-20-03; 93-829, eff. 7-28-04; | 10 |
| 93-841, eff. 7-30-04; 94-48, eff. 7-1-05; 94-838, eff. 6-6-06; | 11 |
| revised 10-19-06.)
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| Section 15. The Illinois Public Aid Code is amended by | 13 |
| changing Section 5-5.4 as follows: | 14 |
| (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
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| Sec. 5-5.4. Standards of Payment - Department of Healthcare | 16 |
| and Family Services.
The Department of Healthcare and Family | 17 |
| Services shall develop standards of payment of skilled
nursing | 18 |
| and intermediate care services in facilities providing such | 19 |
| services
under this Article which:
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| (1) Provide for the determination of a facility's payment
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| for skilled nursing and intermediate care services on a | 22 |
| prospective basis.
The amount of the payment rate for all | 23 |
| nursing facilities certified by the
Department of Public Health | 24 |
| under the Nursing Home Care Act as Intermediate
Care for the |
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| Developmentally Disabled facilities, Long Term Care for Under | 2 |
| Age
22 facilities, Skilled Nursing facilities, or Intermediate | 3 |
| Care facilities
under the
medical assistance program shall be | 4 |
| prospectively established annually on the
basis of historical, | 5 |
| financial, and statistical data reflecting actual costs
from | 6 |
| prior years, which shall be applied to the current rate year | 7 |
| and updated
for inflation, except that the capital cost element | 8 |
| for newly constructed
facilities shall be based upon projected | 9 |
| budgets. The annually established
payment rate shall take | 10 |
| effect on July 1 in 1984 and subsequent years. No rate
increase | 11 |
| and no
update for inflation shall be provided on or after July | 12 |
| 1, 1994 and before
July 1, 2008
2007 , unless specifically | 13 |
| provided for in this
Section.
The changes made by Public Act | 14 |
| 93-841
extending the duration of the prohibition against a rate | 15 |
| increase or update for inflation are effective retroactive to | 16 |
| July 1, 2004.
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| For facilities licensed by the Department of Public Health | 18 |
| under the Nursing
Home Care Act as Intermediate Care for the | 19 |
| Developmentally Disabled facilities
or Long Term Care for Under | 20 |
| Age 22 facilities, the rates taking effect on July
1, 1998 | 21 |
| shall include an increase of 3%. For facilities licensed by the
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| 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,
1998 shall include an | 25 |
| increase of 3% plus $1.10 per resident-day, as defined by
the | 26 |
| Department. For facilities licensed by the Department of Public |
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| Health under the Nursing Home Care Act as Intermediate Care | 2 |
| Facilities for the Developmentally Disabled or Long Term Care | 3 |
| for Under Age 22 facilities, the rates taking effect on January | 4 |
| 1, 2006 shall include an increase of 3%.
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| For facilities licensed by the Department of Public Health | 6 |
| under the
Nursing Home Care Act as Intermediate Care for the | 7 |
| Developmentally Disabled
facilities or Long Term Care for Under | 8 |
| Age 22 facilities, the rates taking
effect on July 1, 1999 | 9 |
| shall include an increase of 1.6% plus $3.00 per
resident-day, | 10 |
| as defined by the Department. For facilities licensed by the
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| Department of Public Health under the Nursing Home Care Act as | 12 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 13 |
| the rates taking effect on July 1,
1999 shall include an | 14 |
| increase of 1.6% and, for services provided on or after
October | 15 |
| 1, 1999, shall be increased by $4.00 per resident-day, as | 16 |
| defined by
the Department.
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| For facilities licensed by the Department of Public Health | 18 |
| under the
Nursing Home Care Act as Intermediate Care for the | 19 |
| Developmentally Disabled
facilities or Long Term Care for Under | 20 |
| Age 22 facilities, the rates taking
effect on July 1, 2000 | 21 |
| shall include an increase of 2.5% per resident-day,
as defined | 22 |
| by the Department. For facilities licensed by the Department of
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| Public Health under the Nursing Home Care Act as Skilled | 24 |
| Nursing facilities or
Intermediate Care facilities, the rates | 25 |
| taking effect on July 1, 2000 shall
include an increase of 2.5% | 26 |
| per resident-day, as defined by the Department.
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| For facilities licensed by the Department of Public Health | 2 |
| under the
Nursing Home Care Act as skilled nursing facilities | 3 |
| or intermediate care
facilities, a new payment methodology must | 4 |
| be implemented for the nursing
component of the rate effective | 5 |
| July 1, 2003. The Department of Public Aid
(now Healthcare and | 6 |
| Family Services) shall develop the new payment methodology | 7 |
| using the Minimum Data Set
(MDS) as the instrument to collect | 8 |
| information concerning nursing home
resident condition | 9 |
| necessary to compute the rate. The Department
shall develop the | 10 |
| new payment methodology to meet the unique needs of
Illinois | 11 |
| nursing home residents while remaining subject to the | 12 |
| appropriations
provided by the General Assembly.
A transition | 13 |
| period from the payment methodology in effect on June 30, 2003
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| to the payment methodology in effect on July 1, 2003 shall be | 15 |
| provided for a
period not exceeding 3 years and 184 days after | 16 |
| implementation of the new payment
methodology as follows:
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| (A) For a facility that would receive a lower
nursing | 18 |
| component rate per patient day under the new system than | 19 |
| the facility
received
effective on the date immediately | 20 |
| preceding the date that the Department
implements the new | 21 |
| payment methodology, the nursing component rate per | 22 |
| patient
day for the facility
shall be held at
the level in | 23 |
| effect on the date immediately preceding the date that the
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| Department implements the new payment methodology until a | 25 |
| higher nursing
component rate of
reimbursement is achieved | 26 |
| by that
facility.
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| (B) For a facility that would receive a higher nursing | 2 |
| component rate per
patient day under the payment | 3 |
| methodology in effect on July 1, 2003 than the
facility | 4 |
| received effective on the date immediately preceding the | 5 |
| date that the
Department implements the new payment | 6 |
| methodology, the nursing component rate
per patient day for | 7 |
| the facility shall be adjusted.
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| (C) Notwithstanding paragraphs (A) and (B), the | 9 |
| nursing component rate per
patient day for the facility | 10 |
| shall be adjusted subject to appropriations
provided by the | 11 |
| General Assembly.
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| For facilities licensed by the Department of Public Health | 13 |
| under the
Nursing Home Care Act as Intermediate Care for the | 14 |
| Developmentally Disabled
facilities or Long Term Care for Under | 15 |
| Age 22 facilities, the rates taking
effect on March 1, 2001 | 16 |
| shall include a statewide increase of 7.85%, as
defined by the | 17 |
| Department.
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| For facilities licensed by the Department of Public Health | 19 |
| under the
Nursing Home Care Act as Intermediate Care for the | 20 |
| Developmentally Disabled
facilities or Long Term Care for Under | 21 |
| Age 22 facilities, the rates taking
effect on April 1, 2002 | 22 |
| shall include a statewide increase of 2.0%, as
defined by the | 23 |
| Department.
This increase terminates on July 1, 2002;
beginning | 24 |
| July 1, 2002 these rates are reduced to the level of the rates
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| in effect on March 31, 2002, as defined by the Department.
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| For facilities licensed by the Department of Public Health |
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| under the
Nursing Home Care Act as skilled nursing facilities | 2 |
| or intermediate care
facilities, the rates taking effect on | 3 |
| July 1, 2001 shall be computed using the most recent cost | 4 |
| reports
on file with the Department of Public Aid no later than | 5 |
| April 1, 2000,
updated for inflation to January 1, 2001. For | 6 |
| rates effective July 1, 2001
only, rates shall be the greater | 7 |
| of the rate computed for July 1, 2001
or the rate effective on | 8 |
| June 30, 2001.
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| Notwithstanding any other provision of this Section, for | 10 |
| facilities
licensed by the Department of Public Health under | 11 |
| the Nursing Home Care Act
as skilled nursing facilities or | 12 |
| intermediate care facilities, the Illinois
Department shall | 13 |
| determine by rule the rates taking effect on July 1, 2002,
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| which shall be 5.9% less than the rates in effect on June 30, | 15 |
| 2002.
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| Notwithstanding any other provision of this Section, for | 17 |
| facilities
licensed by the Department of Public Health under | 18 |
| the Nursing Home Care Act as
skilled nursing
facilities or | 19 |
| intermediate care facilities, if the payment methodologies | 20 |
| required under Section 5A-12 and the waiver granted under 42 | 21 |
| CFR 433.68 are approved by the United States Centers for | 22 |
| Medicare and Medicaid Services, the rates taking effect on July | 23 |
| 1, 2004 shall be 3.0% greater than the rates in effect on June | 24 |
| 30, 2004. These rates shall take
effect only upon approval and
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| implementation of the payment methodologies required under | 26 |
| Section 5A-12.
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| Notwithstanding any other provisions of this Section, for | 2 |
| facilities licensed by the Department of Public Health under | 3 |
| the Nursing Home Care Act as skilled nursing facilities or | 4 |
| intermediate care facilities, the rates taking effect on | 5 |
| January 1, 2005 shall be 3% more than the rates in effect on | 6 |
| December 31, 2004.
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| Notwithstanding any other provisions of this Section, for | 8 |
| facilities licensed by the Department of Public Health under | 9 |
| the Nursing Home Care Act as intermediate care facilities that | 10 |
| are federally defined as Institutions for Mental Disease, a | 11 |
| socio-development component rate equal to 6.6% of the | 12 |
| facility's nursing component rate as of January 1, 2006 shall | 13 |
| be established and paid effective July 1, 2006. The Illinois | 14 |
| Department may by rule adjust these socio-development | 15 |
| component rates, but in no case may such rates be diminished.
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| 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 as long-term care | 19 |
| facilities for
residents under 22 years of age, the rates | 20 |
| taking effect on July 1,
2003 shall
include a statewide | 21 |
| increase of 4%, as defined by the Department.
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| Notwithstanding any other provision of this Section, for | 23 |
| facilities licensed by the Department of Public Health under | 24 |
| the Nursing Home Care Act as skilled nursing facilities or | 25 |
| intermediate care facilities, effective January 1, 2005, | 26 |
| facility rates shall be increased by the difference between (i) |
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| a facility's per diem property, liability, and malpractice | 2 |
| insurance costs as reported in the cost report filed with the | 3 |
| Department of Public Aid and used to establish rates effective | 4 |
| July 1, 2001 and (ii) those same costs as reported in the | 5 |
| facility's 2002 cost report. These costs shall be passed | 6 |
| through to the facility without caps or limitations, except for | 7 |
| adjustments required under normal auditing procedures.
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| Rates established effective each July 1 shall govern | 9 |
| payment
for services rendered throughout that fiscal year, | 10 |
| except that rates
established on July 1, 1996 shall be | 11 |
| increased by 6.8% for services
provided on or after January 1, | 12 |
| 1997. Such rates will be based
upon the rates calculated for | 13 |
| the year beginning July 1, 1990, and for
subsequent years | 14 |
| thereafter until June 30, 2001 shall be based on the
facility | 15 |
| cost reports
for the facility fiscal year ending at any point | 16 |
| in time during the previous
calendar year, updated to the | 17 |
| midpoint of the rate year. The cost report
shall be on file | 18 |
| with the Department no later than April 1 of the current
rate | 19 |
| year. Should the cost report not be on file by April 1, the | 20 |
| Department
shall base the rate on the latest cost report filed | 21 |
| by each skilled care
facility and intermediate care facility, | 22 |
| updated to the midpoint of the
current rate year. In | 23 |
| determining rates for services rendered on and after
July 1, | 24 |
| 1985, fixed time shall not be computed at less than zero. The
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| Department shall not make any alterations of regulations which | 26 |
| would reduce
any component of the Medicaid rate to a level |
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| below what that component would
have been utilizing in the rate | 2 |
| effective on July 1, 1984.
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| (2) Shall take into account the actual costs incurred by | 4 |
| facilities
in providing services for recipients of skilled | 5 |
| nursing and intermediate
care services under the medical | 6 |
| assistance program.
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| (3) Shall take into account the medical and psycho-social
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| characteristics and needs of the patients.
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| (4) Shall take into account the actual costs incurred by | 10 |
| facilities in
meeting licensing and certification standards | 11 |
| imposed and prescribed by the
State of Illinois, any of its | 12 |
| political subdivisions or municipalities and by
the U.S. | 13 |
| Department of Health and Human Services pursuant to Title XIX | 14 |
| of the
Social Security Act.
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| The Department of Healthcare and Family Services
shall | 16 |
| develop precise standards for
payments to reimburse nursing | 17 |
| facilities for any utilization of
appropriate rehabilitative | 18 |
| personnel for the provision of rehabilitative
services which is | 19 |
| authorized by federal regulations, including
reimbursement for | 20 |
| services provided by qualified therapists or qualified
| 21 |
| assistants, and which is in accordance with accepted | 22 |
| professional
practices. Reimbursement also may be made for | 23 |
| utilization of other
supportive personnel under appropriate | 24 |
| supervision.
| 25 |
| (Source: P.A. 93-20, eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, | 26 |
| eff. 2-3-04; 93-841, eff. 7-30-04; 93-1087, eff. 2-28-05; |
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| 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; 94-697, eff. 11-21-05; | 2 |
| 94-838, eff. 6-6-06; 94-964, eff. 6-28-06; revised 8-3-06.)
| 3 |
| Section 20. The Hemophilia Care Act is amended by changing | 4 |
| Section 1 and by adding Sections 1.5 and 2.5 as follows:
| 5 |
| (410 ILCS 420/1) (from Ch. 111 1/2, par. 2901)
| 6 |
| Sec. 1. Definitions. As used in this Act, unless the | 7 |
| context clearly
requires otherwise:
| 8 |
| (1) "Department" means the Illinois Department of | 9 |
| Healthcare and Family Services
Public Aid .
| 10 |
| (1.5) "Director" means the Director of Healthcare and | 11 |
| Family Services and the Director of Insurance
Public Aid .
| 12 |
| (2) (Blank).
| 13 |
| (3) "Hemophilia" means a bleeding tendency resulting from a | 14 |
| genetically
determined deficiency in the blood.
| 15 |
| (4) (Blank).
"Committee" means the Hemophilia Advisory | 16 |
| Committee created under this
Act.
| 17 |
| (5) "Eligible person" means any resident of the State | 18 |
| suffering from
hemophilia.
| 19 |
| (6) "Family" means:
| 20 |
| (a) In the case of a patient who is a dependent of | 21 |
| another person or
couple
as defined by the Illinois Income | 22 |
| Tax Act, all those persons for whom exemption
is claimed in | 23 |
| the State income tax return of the person or couple whose
| 24 |
| dependent the eligible person is, and
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| (b) In all other cases, all those persons for whom | 2 |
| exemption is
claimed
in the State income tax return of the | 3 |
| eligible person, or of the eligible
person and his spouse.
| 4 |
| (7) "Eligible cost of hemophilia services" means the cost | 5 |
| of blood
transfusions,
blood derivatives, and for outpatient | 6 |
| services, of physician charges, medical
supplies, and | 7 |
| appliances, used in the treatment of eligible persons for
| 8 |
| hemophilia, plus one half of the cost of hospital inpatient | 9 |
| care, minus
any amount of such cost which is eligible for | 10 |
| payment or reimbursement by
any hospital or medical insurance | 11 |
| program, by any other government medical
or financial | 12 |
| assistance program, or by any charitable assistance
program.
| 13 |
| (8) "Gross income" means the base income for State income | 14 |
| tax purposes
of all members of the family.
| 15 |
| (9) "Available family income" means the lesser of:
| 16 |
| (a) Gross income minus the sum of (1) $5,500,
and (2) | 17 |
| $3,500 times the number of persons
in the family, or
| 18 |
| (b) One half of gross income.
| 19 |
| (10) "Board" means the Hemophilia Advisory Review Board.
| 20 |
| (Source: P.A. 89-507, eff. 7-1-97; 90-587, eff. 7-1-98; revised | 21 |
| 12-15-05.)
| 22 |
| (410 ILCS 420/1.5 new) | 23 |
| Sec. 1.5. Findings. The General Assembly finds all of the | 24 |
| following: | 25 |
| (1) Inherited hemophilia and other bleeding disorders |
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| are devastating health conditions that can cause serious | 2 |
| financial, social, and emotional hardships for patients | 3 |
| and their families. Hemophilia, which occurs predominantly | 4 |
| in males, is a rare but well-known type of inherited | 5 |
| bleeding disorder in which one of several proteins normally | 6 |
| found in blood are either deficient or inactive, and | 7 |
| causing pain, swelling, and permanent damage to joints and | 8 |
| muscles. The disorder affects Americans of all racial and | 9 |
| ethnic backgrounds. In about one-third of all cases, there | 10 |
| is no known family history of the disorder. In these cases, | 11 |
| the disease developed after a new or spontaneous gene | 12 |
| mutation. | 13 |
| (2) Hemophilia is one of a spectrum of devastating | 14 |
| chronic bleeding disorders impacting Americans. Von | 15 |
| Willebrand Disease, another type of bleeding disorder, is | 16 |
| caused by a deficiency on the von Willebrand protein. | 17 |
| Persons with the disorder often bruise easily, have | 18 |
| frequent nosebleeds, or bleed after tooth extraction, | 19 |
| tonsillectomy, or other surgery. In some instances, women | 20 |
| will have prolonged menstrual bleeding. The disorder | 21 |
| occurs in about 1% to 2% of the U.S. population. | 22 |
| (3) Appropriate care and treatment are necessities for | 23 |
| maintaining optimum health for persons afflicted with | 24 |
| hemophilia and other bleeding disorders. | 25 |
| (4) While hemophilia and other bleeding disorders are | 26 |
| incurable, advancements in drug therapies are allowing |
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| individuals greater latitude in managing their conditions, | 2 |
| fostering independence, and minimizing chronic | 3 |
| complications such as damage to the joints and muscles, | 4 |
| blood-transmitted infectious diseases, and chronic liver | 5 |
| diseases. At the same time, treatment for clotting | 6 |
| disorders is saving more and more lives. The rarity of | 7 |
| these disorders coupled with the delicate processes for | 8 |
| producing factors, however, makes treating these disorders | 9 |
| extremely costly. As a result, insurance coverage is a | 10 |
| major concern for patients and their families. | 11 |
| (5) It is thus the intent of the General Assembly | 12 |
| through implementation of this Act to establish an advisory | 13 |
| board to provide expert advice to the State on health and | 14 |
| insurance policies, plans, and public health programs that | 15 |
| impact individuals with hemophilia and other bleeding | 16 |
| disorders. | 17 |
| (410 ILCS 420/2.5 new) | 18 |
| Sec. 2.5. Hemophilia Advisory Review Board. | 19 |
| (a) The Director of Public Health in collaboration and in | 20 |
| consultation with the Director of Insurance, shall establish an | 21 |
| independent advisory board known as the Hemophilia Advisory | 22 |
| Review Board. The Board shall review, may comment upon, and | 23 |
| make recommendations to the Directors with regard to, but not | 24 |
| limited to the following: | 25 |
| (1) Proposed legislative or administrative changes to |
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| policies and programs that are integral to the health and | 2 |
| wellness of individuals with hemophilia and other bleeding | 3 |
| disorders. | 4 |
| (2) Standards of care and treatment for persons living | 5 |
| with hemophilia and other bleeding disorders. In examining | 6 |
| standards of care, the Board shall protect open access to | 7 |
| any and all treatments for hemophilia and other bleeding | 8 |
| disorders, in accordance with federal guidelines and | 9 |
| standards of care guidelines developed by the Medical and | 10 |
| Scientific Advisory Council (MASAC) of National Hemophilia | 11 |
| Foundation (NHF), an internationally recognized body whose | 12 |
| guidelines set the standards of care for hemophilia and | 13 |
| other bleeding disorders around the world. | 14 |
| (3) The development of community-based initiatives to | 15 |
| increase awareness of care and treatment for persons living | 16 |
| with hemophilia and other bleeding disorders. The | 17 |
| Department of Health may provide such services through | 18 |
| cooperative agreements with Hemophilia Treatment Centers, | 19 |
| medical facilities, schools, nonprofit organizations | 20 |
| servicing the bleeding disorder community, or other | 21 |
| appropriate means. | 22 |
| (4) Facilitating linkages for persons with hemophilia | 23 |
| and other bleeding disorders. | 24 |
| (5) Protecting the rights of people living with | 25 |
| hemophilia and other bleeding disorders to appropriate | 26 |
| health insurance coverage be it under a private or |
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| State-sponsored health insurance provider. | 2 |
| (b) The Board shall consist of the Director of Healthcare | 3 |
| and Family Services and the Director of Insurance or their | 4 |
| designee, who shall serve as non-voting members, and 7 voting | 5 |
| members appointed by the Governor in consultation and in | 6 |
| collaboration with the Directors. The voting members shall be | 7 |
| selected from among the following member groups: | 8 |
| (1) one board-certified physician licensed, practicing | 9 |
| and currently treating individuals with hemophilia or | 10 |
| other bleeding disorders; | 11 |
| (2) one nurse licensed, practicing and currently | 12 |
| treating individuals with hemophilia or other bleeding | 13 |
| disorders; | 14 |
| (3) one social worker licensed, practicing and | 15 |
| currently treating individuals with hemophilia or other | 16 |
| bleeding disorders; | 17 |
| (4) one representative of a federally funded | 18 |
| Hemophilia Treatment Center; | 19 |
| (5) one representative of an organization established | 20 |
| under the Illinois Insurance Code for the purpose of | 21 |
| providing health insurance; | 22 |
| (6) one representative of a voluntary health | 23 |
| organization that currently services the hemophilia and | 24 |
| other bleeding disorders community; and | 25 |
| (7) one patient or caregiver of a patient with | 26 |
| hemophilia or other bleeding disorder.
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| The Board may also have up to 5 additional nonvoting members as | 2 |
| determined appropriate by the Directors. Nonvoting members may | 3 |
| be persons with or caregivers of a patient with hemophilia or a | 4 |
| bleeding disorder other than hemophilia or persons experienced | 5 |
| in the diagnosis, treatment, care, and support of individuals | 6 |
| with hemophilia or other bleeding disorders. | 7 |
| No more than a majority of the voting members may be of the | 8 |
| same political party.
Members of the Board shall elect one of | 9 |
| its members to act as chair for a term of 3 years. The chair | 10 |
| shall retain all voting rights. If there is a vacancy on the | 11 |
| Board, such position may be filled in the same manner as the | 12 |
| original appointment.
Members of the Board shall receive no | 13 |
| compensation, but may be reimbursed for actual expenses | 14 |
| incurred in the carrying out of their duties. The Board shall | 15 |
| meet no less than 4 times per year and follow all policies and | 16 |
| procedures of the State of Illinois Open Meetings Law. | 17 |
| (c) No later than 6 months after the date of enactment of | 18 |
| this amendatory Act, the Board shall submit to the Governor and | 19 |
| the General Assembly a report with recommendations for | 20 |
| maintaining access to care and obtaining appropriate health | 21 |
| insurance coverage for individuals with hemophilia and other | 22 |
| bleeding disorders. The report shall be subject to public | 23 |
| review and comment prior to adoption. No later than 6 months | 24 |
| after adoption by the Governor and Legislature and annually | 25 |
| thereafter, the Director of Healthcare and Family Services | 26 |
| shall issue a report, which shall be made available to the |
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| public, on the status of implementing the recommendations as | 2 |
| proposed by the Board and on any state and national activities | 3 |
| with regard to hemophilia and other bleeding disorders.
| 4 |
| (410 ILCS 420/4 rep.)
| 5 |
| Section 21. The Hemophilia Care Act is amended by repealing | 6 |
| Section 4.
| 7 |
| Section 99. Effective date. This Act takes effect upon | 8 |
| becoming law.
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