Public Act 098-0727
 
HB4600 EnrolledLRB098 17867 KTG 52991 b

    AN ACT concerning public aid.
 
    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 5-5.2 as follows:
 
    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
    Sec. 5-5.2. Payment.
    (a) All nursing facilities that are grouped pursuant to
Section 5-5.1 of this Act shall receive the same rate of
payment for similar services.
    (b) It shall be a matter of State policy that the Illinois
Department shall utilize a uniform billing cycle throughout the
State for the long-term care providers.
    (c) Notwithstanding any other provisions of this Code, the
methodologies for reimbursement of nursing services as
provided under this Article shall no longer be applicable for
bills payable for nursing services rendered on or after a new
reimbursement system based on the Resource Utilization Groups
(RUGs) has been fully operationalized, which shall take effect
for services provided on or after January 1, 2014.
    (d) The new nursing services reimbursement methodology
utilizing RUG-IV 48 grouper model, which shall be referred to
as the RUGs reimbursement system, taking effect January 1,
2014, shall be based on the following:
        (1) The methodology shall be resident-driven,
    facility-specific, and cost-based.
        (2) Costs shall be annually rebased and case mix index
    quarterly updated. The nursing services methodology will
    be assigned to the Medicaid enrolled residents on record as
    of 30 days prior to the beginning of the rate period in the
    Department's Medicaid Management Information System (MMIS)
    as present on the last day of the second quarter preceding
    the rate period based upon the Assessment Reference Date of
    the Minimum Data Set (MDS).
        (3) Regional wage adjustors based on the Health Service
    Areas (HSA) groupings and adjusters in effect on April 30,
    2012 shall be included.
        (4) Case mix index shall be assigned to each resident
    class based on the Centers for Medicare and Medicaid
    Services staff time measurement study in effect on July 1,
    2013, utilizing an index maximization approach.
        (5) The pool of funds available for distribution by
    case mix and the base facility rate shall be determined
    using the formula contained in subsection (d-1).
    (d-1) Calculation of base year Statewide RUG-IV nursing
base per diem rate.
        (1) Base rate spending pool shall be:
            (A) The base year resident days which are
        calculated by multiplying the number of Medicaid
        residents in each nursing home as indicated in the MDS
        data defined in paragraph (4) by 365.
            (B) Each facility's nursing component per diem in
        effect on July 1, 2012 shall be multiplied by
        subsection (A).
            (C) Thirteen million is added to the product of
        subparagraph (A) and subparagraph (B) to adjust for the
        exclusion of nursing homes defined in paragraph (5).
        (2) For each nursing home with Medicaid residents as
    indicated by the MDS data defined in paragraph (4),
    weighted days adjusted for case mix and regional wage
    adjustment shall be calculated. For each home this
    calculation is the product of:
            (A) Base year resident days as calculated in
        subparagraph (A) of paragraph (1).
            (B) The nursing home's regional wage adjustor
        based on the Health Service Areas (HSA) groupings and
        adjustors in effect on April 30, 2012.
            (C) Facility weighted case mix which is the number
        of Medicaid residents as indicated by the MDS data
        defined in paragraph (4) multiplied by the associated
        case weight for the RUG-IV 48 grouper model using
        standard RUG-IV procedures for index maximization.
            (D) The sum of the products calculated for each
        nursing home in subparagraphs (A) through (C) above
        shall be the base year case mix, rate adjusted weighted
        days.
        (3) The Statewide RUG-IV nursing base per diem rate on
    January 1, 2014 shall be the quotient of the paragraph (1)
    divided by the sum calculated under subparagraph (D) of
    paragraph (2).
        (4) Minimum Data Set (MDS) comprehensive assessments
    for Medicaid residents on the last day of the quarter used
    to establish the base rate.
        (5) Nursing facilities designated as of July 1, 2012 by
    the Department as "Institutions for Mental Disease" shall
    be excluded from all calculations under this subsection.
    The data from these facilities shall not be used in the
    computations described in paragraphs (1) through (4) above
    to establish the base rate.
    (e) Notwithstanding any other provision of this Code, the
Department shall by rule develop a reimbursement methodology
reflective of the intensity of care and services requirements
of low need residents in the lowest RUG IV groupers and
corresponding regulations. Only that portion of the RUGs
Reimbursement System spending pool described in subsection
(d-1) attributed to the groupers as of July 1, 2013 for which
the methodology in this Section is developed may be diverted
for this purpose. The Department shall submit the rules no
later than January 1, 2014 for an implementation date no later
than January 1, 2015. If the Department does not implement this
reimbursement methodology by the required date, the nursing
component per diem on January 1, 2015 for residents classified
in RUG-IV groups PA1, PA2, BA1, and BA2 shall be the blended
rate of the calculated RUG-IV nursing component per diem and
the nursing component per diem in effect on July 1, 2012. This
blended rate shall be applied only to nursing homes whose
resident population is greater than or equal to 70% of the
total residents served and whose RUG-IV nursing component per
diem rate is less than the nursing component per diem in effect
on July 1, 2012. This blended rate shall be in effect until the
reimbursement methodology is implemented or until July 1, 2019,
whichever is sooner.
    (e-1) Notwithstanding any other provision of this Article,
rates established pursuant to this subsection shall not apply
to any and all nursing facilities designated by the Department
as "Institutions for Mental Disease" and shall be excluded from
the RUGs Reimbursement System applicable to facilities not
designated as "Institutions for the Mentally Diseased" by the
Department.
    (e-2) For dates of services beginning January 1, 2014, the
RUG-IV nursing component per diem for a nursing home shall be
the product of the statewide RUG-IV nursing base per diem rate,
the facility average case mix index, and the regional wage
adjustor. Transition rates for services provided between
January 1, 2014 and December 31, 2014 shall be as follows:
        (1) The transition RUG-IV per diem nursing rate for
    nursing homes whose rate calculated in this subsection
    (e-2) is greater than the nursing component rate in effect
    July 1, 2012 shall be paid the sum of:
            (A) The nursing component rate in effect July 1,
        2012; plus
            (B) The difference of the RUG-IV nursing component
        per diem calculated for the current quarter minus the
        nursing component rate in effect July 1, 2012
        multiplied by 0.88.
        (2) The transition RUG-IV per diem nursing rate for
    nursing homes whose rate calculated in this subsection
    (e-2) is less than the nursing component rate in effect
    July 1, 2012 shall be paid the sum of:
            (A) The nursing component rate in effect July 1,
        2012; plus
            (B) The difference of the RUG-IV nursing component
        per diem calculated for the current quarter minus the
        nursing component rate in effect July 1, 2012
        multiplied by 0.13.
    (f) Notwithstanding any other provision of this Code, on
and after July 1, 2012, reimbursement rates associated with the
nursing or support components of the current nursing facility
rate methodology shall not increase beyond the level effective
May 1, 2011 until a new reimbursement system based on the RUGs
IV 48 grouper model has been fully operationalized.
    (g) Notwithstanding any other provision of this Code, on
and after July 1, 2012, for facilities not designated by the
Department of Healthcare and Family Services as "Institutions
for Mental Disease", rates effective May 1, 2011 shall be
adjusted as follows:
        (1) Individual nursing rates for residents classified
    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
    ending March 31, 2012 shall be reduced by 10%;
        (2) Individual nursing rates for residents classified
    in all other RUG IV groups shall be reduced by 1.0%;
        (3) Facility rates for the capital and support
    components shall be reduced by 1.7%.
    (h) Notwithstanding any other provision of this Code, on
and after July 1, 2012, nursing facilities designated by the
Department of Healthcare and Family Services as "Institutions
for Mental Disease" and "Institutions for Mental Disease" that
are facilities licensed under the Specialized Mental Health
Rehabilitation Act of 2013 shall have the nursing,
socio-developmental, capital, and support components of their
reimbursement rate effective May 1, 2011 reduced in total by
2.7%.
(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section
6-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff.
7-22-13; revised 9-19-13.)
 
    Section 99. Effective date. This Act takes effect upon
becoming law.

Effective Date: 7/16/2014