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


Sen. Sara Feigenholtz

Filed: 2/19/2021





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2    AMENDMENT NO. ______. Amend Senate Bill 110 by replacing
3everything after the enacting clause with the following:
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



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1bills payable for nursing services rendered on or after a new
2reimbursement system based on the Resource Utilization Groups
3(RUGs) has been fully operationalized, which shall take effect
4for services provided on or after January 1, 2014.
5    (d) The new nursing services reimbursement methodology
6utilizing RUG-IV 48 grouper model, which shall be referred to
7as the RUGs reimbursement system, taking effect January 1,
82014, shall be based on the following:
9        (1) The methodology shall be resident-driven,
10    facility-specific, and cost-based.
11        (2) Costs shall be annually rebased and case mix index
12    quarterly updated. The nursing services methodology will
13    be assigned to the Medicaid enrolled residents on record
14    as of 30 days prior to the beginning of the rate period in
15    the Department's Medicaid Management Information System
16    (MMIS) as present on the last day of the second quarter
17    preceding the rate period based upon the Assessment
18    Reference Date of the Minimum Data Set (MDS).
19        (3) Regional wage adjustors based on the Health
20    Service Areas (HSA) groupings and adjusters in effect on
21    April 30, 2012 shall be included, except no adjuster shall
22    be lower than 1.0.
23        (4) Case mix index shall be assigned to each resident
24    class based on the Centers for Medicare and Medicaid
25    Services staff time measurement study in effect on July 1,
26    2013, utilizing an index maximization approach.



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



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1        adjustors in effect on April 30, 2012.
2            (C) Facility weighted case mix which is the number
3        of Medicaid residents as indicated by the MDS data
4        defined in paragraph (4) multiplied by the associated
5        case weight for the RUG-IV 48 grouper model using
6        standard RUG-IV procedures for index maximization.
7            (D) The sum of the products calculated for each
8        nursing home in subparagraphs (A) through (C) above
9        shall be the base year case mix, rate adjusted
10        weighted days.
11        (3) The Statewide RUG-IV nursing base per diem rate:
12            (A) on January 1, 2014 shall be the quotient of the
13        paragraph (1) divided by the sum calculated under
14        subparagraph (D) of paragraph (2); and
15            (B) on and after July 1, 2014, shall be the amount
16        calculated under subparagraph (A) of this paragraph
17        (3) plus $1.76.
18        (4) Minimum Data Set (MDS) comprehensive assessments
19    for Medicaid residents on the last day of the quarter used
20    to establish the base rate.
21        (5) Nursing facilities designated as of July 1, 2012
22    by the Department as "Institutions for Mental Disease"
23    shall be excluded from all calculations under this
24    subsection. The data from these facilities shall not be
25    used in the computations described in paragraphs (1)
26    through (4) above to establish the base rate.



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1    (e) Beginning July 1, 2014, the Department shall allocate
2funding in the amount up to $10,000,000 for per diem add-ons to
3the RUGS methodology for dates of service on and after July 1,
5        (1) $0.63 for each resident who scores in I4200
6    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
7        (2) $2.67 for each resident who scores either a "1" or
8    "2" in any items S1200A through S1200I and also scores in
9    RUG groups PA1, PA2, BA1, or BA2.
10    (e-1) (Blank).
11    (e-2) For dates of services beginning January 1, 2014, the
12RUG-IV nursing component per diem for a nursing home shall be
13the product of the statewide RUG-IV nursing base per diem
14rate, the facility average case mix index, and the regional
15wage adjustor. Transition rates for services provided between
16January 1, 2014 and December 31, 2014 shall be as follows:
17        (1) The transition RUG-IV per diem nursing rate for
18    nursing homes whose rate calculated in this subsection
19    (e-2) is greater than the nursing component rate in effect
20    July 1, 2012 shall be paid the sum of:
21            (A) The nursing component rate in effect July 1,
22        2012; plus
23            (B) The difference of the RUG-IV nursing component
24        per diem calculated for the current quarter minus the
25        nursing component rate in effect July 1, 2012
26        multiplied by 0.88.



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



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1    in all other RUG IV groups shall be reduced by 1.0%;
2        (3) Facility rates for the capital and support
3    components shall be reduced by 1.7%.
4    (h) Notwithstanding any other provision of this Code, on
5and after July 1, 2012, nursing facilities designated by the
6Department of Healthcare and Family Services as "Institutions
7for Mental Disease" and "Institutions for Mental Disease" that
8are facilities licensed under the Specialized Mental Health
9Rehabilitation Act of 2013 shall have the nursing,
10socio-developmental, capital, and support components of their
11reimbursement rate effective May 1, 2011 reduced in total by
13    (i) On and after July 1, 2014, the reimbursement rates for
14the support component of the nursing facility rate for
15facilities licensed under the Nursing Home Care Act as skilled
16or intermediate care facilities shall be the rate in effect on
17June 30, 2014 increased by 8.17%.
18    (j) Notwithstanding any other provision of law, subject to
19federal approval, effective July 1, 2019, sufficient funds
20shall be allocated for changes to rates for facilities
21licensed under the Nursing Home Care Act as skilled nursing
22facilities or intermediate care facilities for dates of
23services on and after July 1, 2019: (i) to establish a per diem
24add-on to the direct care per diem rate not to exceed
25$70,000,000 annually in the aggregate taking into account
26federal matching funds for the purpose of addressing the



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1facility's unique staffing needs, adjusted quarterly and
2distributed by a weighted formula based on Medicaid bed days
3on the last day of the second quarter preceding the quarter for
4which the rate is being adjusted; and (ii) in an amount not to
5exceed $170,000,000 annually in the aggregate taking into
6account federal matching funds to permit the support component
7of the nursing facility rate to 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 and taking into account subsection (i).
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    To implement item (i) in this subsection, facilities shall
24file quarterly reports documenting compliance with its
25annually approved staffing plan, which shall permit compliance
26with Section 3-202.05 of the Nursing Home Care Act. A facility



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1that fails to meet the benchmarks and dates contained in the
2plan may have its add-on adjusted in the quarter following the
3quarterly review. Nothing in this Section shall limit the
4ability of the facility to appeal a ruling of non-compliance
5and a subsequent reduction to the add-on. Funds adjusted for
6noncompliance shall be maintained in the Long-Term Care
7Provider Fund and accounted for separately. At the end of each
8fiscal year, these funds shall be made available to facilities
9for special staffing projects.
10    In order to provide for the expeditious and timely
11implementation of the provisions of Public Act 101-10 this
12amendatory Act of the 101st General Assembly, emergency rules
13to implement any provision of Public Act 101-10 this
14amendatory Act of the 101st General Assembly may be adopted in
15accordance with this subsection by the agency charged with
16administering that provision or initiative. The agency shall
17simultaneously file emergency rules and permanent rules to
18ensure that there is no interruption in administrative
19guidance. The 150-day limitation of the effective period of
20emergency rules does not apply to rules adopted under this
21subsection, and the effective period may continue through June
2230, 2021. The 24-month limitation on the adoption of emergency
23rules does not apply to rules adopted under this subsection.
24The adoption of emergency rules authorized by this subsection
25is deemed to be necessary for the public interest, safety, and



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1    (k) (j) During the first quarter of State Fiscal Year
22020, the Department of Healthcare of Family Services must
3convene a technical advisory group consisting of members of
4all trade associations representing Illinois skilled nursing
5providers to discuss changes necessary with federal
6implementation of Medicare's Patient-Driven Payment Model.
7Implementation of Medicare's Patient-Driven Payment Model
8shall, by September 1, 2020, end the collection of the MDS data
9that is necessary to maintain the current RUG-IV Medicaid
10payment methodology. The technical advisory group must
11consider a revised reimbursement methodology that takes into
12account transparency, accountability, actual staffing as
13reported under the federally required Payroll Based Journal
14system, changes to the minimum wage, adequacy in coverage of
15the cost of care, and a quality component that rewards quality
17(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
18revised 9-18-19.)
19    Section 99. Effective date. This Act takes effect upon
20becoming law.".