Public Act 93-0649
HB2657 Enrolled LRB093 04135 RCE 04178 b
AN ACT in relation to budget implementation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 5-5.4 as follows:
(305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
Sec. 5-5.4. Standards of Payment - Department of Public
Aid. The Department of Public Aid shall develop standards of
payment of skilled nursing and intermediate care services in
facilities providing such services under this Article which:
(1) Provide for the determination of a facility's
payment for skilled nursing and intermediate care services on
a prospective basis. The amount of the payment rate for all
nursing facilities certified by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities, Long Term Care
for Under Age 22 facilities, Skilled Nursing facilities, or
Intermediate Care facilities under the medical assistance
program shall be prospectively established annually on the
basis of historical, financial, and statistical data
reflecting actual costs from prior years, which shall be
applied to the current rate year and updated for inflation,
except that the capital cost element for newly constructed
facilities shall be based upon projected budgets. The
annually established payment rate shall take effect on July 1
in 1984 and subsequent years. No rate increase and no update
for inflation shall be provided on or after July 1, 1994 and
before July 1, 2004, unless specifically provided for in this
Section.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on July
1, 1998 shall include an increase of 3%. For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Skilled Nursing facilities or Intermediate
Care facilities, the rates taking effect on July 1, 1998
shall include an increase of 3% plus $1.10 per resident-day,
as defined by the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on July
1, 1999 shall include an increase of 1.6% plus $3.00 per
resident-day, as defined by the Department. For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Skilled Nursing facilities or Intermediate
Care facilities, the rates taking effect on July 1, 1999
shall include an increase of 1.6% and, for services provided
on or after October 1, 1999, shall be increased by $4.00 per
resident-day, as defined by the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on July
1, 2000 shall include an increase of 2.5% per resident-day,
as defined by the Department. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act
as Skilled Nursing facilities or Intermediate Care
facilities, the rates taking effect on July 1, 2000 shall
include an increase of 2.5% per resident-day, as defined by
the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as skilled nursing
facilities or intermediate care facilities, a new payment
methodology must be implemented for the nursing component of
the rate effective July 1, 2003. The Department of Public Aid
shall develop the new payment methodology using the Minimum
Data Set (MDS) as the instrument to collect information
concerning nursing home resident condition necessary to
compute the rate. The Department of Public Aid shall develop
the new payment methodology to meet the unique needs of
Illinois nursing home residents while remaining subject to
the appropriations provided by the General Assembly. A
transition period from the payment methodology in effect on
June 30, 2003 to the payment methodology in effect on July 1,
2003 shall be provided for a period not exceeding 2 years
after implementation of the new payment methodology as
follows:
(A) For a facility that would receive a lower
nursing component rate per patient day under the new
system than the facility received effective on the date
immediately preceding the date that the Department
implements the new payment methodology, the nursing
component rate per patient day for the facility shall be
held at the level in effect on the date immediately
preceding the date that the Department implements the new
payment methodology until a higher nursing component rate
of reimbursement is achieved by that facility.
(B) For a facility that would receive a higher
nursing component rate per patient day under the payment
methodology in effect on July 1, 2003 than the facility
received effective on the date immediately preceding the
date that the Department implements the new payment
methodology, the nursing component rate per patient day
for the facility shall be adjusted.
(C) Notwithstanding paragraphs (A) and (B), the
nursing component rate per patient day for the facility
shall be adjusted subject to appropriations provided by
the General Assembly.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on March
1, 2001 shall include a statewide increase of 7.85%, as
defined by the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on April
1, 2002 shall include a statewide increase of 2.0%, as
defined by the Department. This increase terminates on July
1, 2002; beginning July 1, 2002 these rates are reduced to
the level of the rates in effect on March 31, 2002, as
defined by the Department.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as skilled nursing
facilities or intermediate care facilities, the rates taking
effect on July 1, 2001 shall be computed using the most
recent cost reports on file with the Department of Public Aid
no later than April 1, 2000, updated for inflation to January
1, 2001. For rates effective July 1, 2001 only, rates shall
be the greater of the rate computed for July 1, 2001 or the
rate effective on June 30, 2001.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the Illinois Department shall
determine by rule the rates taking effect on July 1, 2002,
which shall be 5.9% less than the rates in effect on June 30,
2002.
For facilities licensed by the Department of Public
Health under the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or as long-term
care facilities for residents under 22 years of age, the
rates taking effect on July 1, 2003 shall include a statewide
increase of 4%, as defined by the Department.
Rates established effective each July 1 shall govern
payment for services rendered throughout that fiscal year,
except that rates established on July 1, 1996 shall be
increased by 6.8% for services provided on or after January
1, 1997. Such rates will be based upon the rates calculated
for the year beginning July 1, 1990, and for subsequent years
thereafter until June 30, 2001 shall be based on the facility
cost reports for the facility fiscal year ending at any point
in time during the previous calendar year, updated to the
midpoint of the rate year. The cost report shall be on file
with the Department no later than April 1 of the current rate
year. Should the cost report not be on file by April 1, the
Department shall base the rate on the latest cost report
filed by each skilled care facility and intermediate care
facility, updated to the midpoint of the current rate year.
In determining rates for services rendered on and after July
1, 1985, fixed time shall not be computed at less than zero.
The Department shall not make any alterations of regulations
which would reduce any component of the Medicaid rate to a
level below what that component would have been utilizing in
the rate effective on July 1, 1984.
(2) Shall take into account the actual costs incurred by
facilities in providing services for recipients of skilled
nursing and intermediate care services under the medical
assistance program.
(3) Shall take into account the medical and
psycho-social characteristics and needs of the patients.
(4) Shall take into account the actual costs incurred by
facilities in meeting licensing and certification standards
imposed and prescribed by the State of Illinois, any of its
political subdivisions or municipalities and by the U.S.
Department of Health and Human Services pursuant to Title XIX
of the Social Security Act.
The Department of Public Aid shall develop precise
standards for payments to reimburse nursing facilities for
any utilization of appropriate rehabilitative personnel for
the provision of rehabilitative services which is authorized
by federal regulations, including reimbursement for services
provided by qualified therapists or qualified assistants, and
which is in accordance with accepted professional practices.
Reimbursement also may be made for utilization of other
supportive personnel under appropriate supervision.
(Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01;
92-597, eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff.
1-1-03; 93-20, eff. 6-20-03.)
Section 99. Effective date. This Act takes effect upon
becoming law.