Bill Text: IL HB0246 | 2021-2022 | 102nd General Assembly | Chaptered

---

Bill Title: Amends the Illinois Public Aid Code. In the Medical Assistance Article, provides that notwithstanding any other provisions of the Code, the methodologies for reimbursement of nursing services shall no longer be applicable for bills payable for nursing services rendered on or after a new reimbursement system based on the Patient Driven Payment Model (PDPM) has been fully operationalized, which shall take effect for services provided on or after the implementation of the PDPM reimbursement system begins. Establishes an implementation date for the PDPM reimbursement system if certain conditions are met. Contains provisions concerning the establishment of a variable per diem staffing add-on for nursing facilities with specified staffing levels; utilization of the Staff Time and Resource Intensity Verification study; the PDPM nursing component per diem for nursing facilities for certain dates of services; a Medicaid Access Adjustment; incentive payments determined by facility performance on specified quality measures; payments based on CNA tenure, promotion, and CNA training for the purpose of increasing CNA compensation; and other matters. In the Long-Term Care Provider Funding Article, provides that for the privilege of engaging in the occupation of long-term care provider for each occupied non-Medicare bed day, beginning July 1, 2022, an assessment is imposed upon each long-term care provider in an amount varying with the number of paid Medicaid resident days per annum in the facility. Sets forth a schedule of occupied bed tax amounts. Makes changes concerning reporting requirements, the Long-Term Care Provider Fund, and other matters. In the Nursing Home License Fee Article, provides that a specified provision imposing licensing fees on nursing home providers is repealed on July 1, 2024. Amends the Illinois Administrative Procedure Act. Grants the Department of Healthcare and Family Services emergency rulemaking authority to implement certain provisions of the amendatory Act. Effective immediately.

Spectrum: Strong Partisan Bill (Democrat 41-4)

Status: (Passed) 2022-05-31 - Public Act . . . . . . . . . 102-1035 [HB0246 Detail]

Download: Illinois-2021-HB0246-Chaptered.html

---

Public Act 102-1035
HB0246 Enrolled LRB102 10452 SPS 15780 b
AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 1. The Illinois Administrative Procedure Act is
amended by adding Section 5-45.21 as follows:
(5 ILCS 100/5-45.21 new)
Sec. 5-45.21. Emergency rulemaking; Department of
Healthcare and Family Services. To provide for the expeditious
and timely implementation of the changes made to Articles 5
and 5B of the Illinois Public Aid Code by this amendatory Act
of the 102nd General Assembly, emergency rules implementing
the changes made to Articles 5 and 5B of the Illinois Public
Aid Code by this amendatory Act of the 102nd General Assembly
may be adopted in accordance with Section 5-45 by the
Department of Healthcare and Family Services. The adoption of
emergency rules authorized by Section 5-45 and this Section is
deemed to be necessary for the public interest, safety, and
welfare.
This Section is repealed on September 30, 2022.
Section 5. The Illinois Public Aid Code is amended by
changing Sections 5-5.2, 5-5.8, 5B-2, 5B-4, 5B-5, 5B-8, and
5E-10 and by adding Section 5E-20 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) (Blank). 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.
(c-1) 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 Patient Driven Payment Model
(PDPM) has been fully operationalized, which shall take effect
for services provided on or after the implementation of the
PDPM reimbursement system begins. For the purposes of this
amendatory Act of the 102nd General Assembly, the
implementation date of the PDPM reimbursement system and all

related provisions shall be July 1, 2022 if the following
conditions are met: (i) the Centers for Medicare and Medicaid
Services has approved corresponding changes in the
reimbursement system and bed assessment; and (ii) the
Department has filed rules to implement these changes no later
than June 1, 2022. Failure of the Department to file rules to
implement the changes provided in this amendatory Act of the
102nd General Assembly no later than June 1, 2022 shall result
in the implementation date being delayed to October 1, 2022.
(d) The new nursing services reimbursement methodology
utilizing the Patient Driven Payment Model RUG-IV 48 grouper
model, which shall be referred to as the PDPM RUGs
reimbursement system, taking effect July 1, 2022, upon federal
approval by the Centers for Medicare and Medicaid Services
January 1, 2014, shall be based on the following:
(1) The methodology shall be resident-centered
resident-driven, facility-specific, cost-based, and based
on guidance from the Centers for Medicare and Medicaid
Services 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, except no adjuster shall
be lower than 1.06 1.0.
(4) PDPM nursing case mix indices in effect on March
1, 2022 Case mix index shall be assigned to each resident
class at no less than 0.7858 of based on the Centers for
Medicare and Medicaid Services PDPM unadjusted case mix
values, in effect on March 1, 2022, 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).
(6) The Department shall establish a variable per diem
staffing add-on in accordance with the most recent
available federal staffing report, currently the Payroll
Based Journal, for the same period of time, and if
applicable adjusted for acuity using the same quarter's
MDS. The Department shall rely on Payroll Based Journals
provided to the Department of Public Health to make a
determination of non-submission. If the Department is
notified by a facility of missing or inaccurate Payroll
Based Journal data or an incorrect calculation of
staffing, the Department must make a correction as soon as

the error is verified for the applicable quarter.
Facilities with at least 70% of the staffing indicated
by the STRIVE study shall be paid a per diem add-on of $9,
increasing by equivalent steps for each whole percentage
point until the facilities reach a per diem of $14.88.
Facilities with at least 80% of the staffing indicated by
the STRIVE study shall be paid a per diem add-on of $14.88,
increasing by equivalent steps for each whole percentage
point until the facilities reach a per diem add-on of
$23.80. Facilities with at least 92% of the staffing
indicated by the STRIVE study shall be paid a per diem
add-on of $23.80, increasing by equivalent steps for each
whole percentage point until the facilities reach a per
diem add-on of $29.75. Facilities with at least 100% of
the staffing indicated by the STRIVE study shall be paid a
per diem add-on of $29.75, increasing by equivalent steps
for each whole percentage point until the facilities reach
a per diem add-on of $35.70. Facilities with at least 110%
of the staffing indicated by the STRIVE study shall be
paid a per diem add-on of $35.70, increasing by equivalent
steps for each whole percentage point until the facilities
reach a per diem add-on of $38.68. Facilities with at
least 125% or higher of the staffing indicated by the
STRIVE study shall be paid a per diem add-on of $38.68.
Beginning April 1, 2023, no nursing facility's variable
staffing per diem add-on shall be reduced by more than 5%

in 2 consecutive quarters. For the quarters beginning July
1, 2022 and October 1, 2022, no facility's variable per
diem staffing add-on shall be calculated at a rate lower
than 85% of the staffing indicated by the STRIVE study. No
facility below 70% of the staffing indicated by the STRIVE
study shall receive a variable per diem staffing add-on
after December 31, 2022.
(7) For dates of services beginning July 1, 2022, the
PDPM nursing component per diem for each nursing facility
shall be the product of the facility's (i) statewide PDPM
nursing base per diem rate, $92.25, adjusted for the
facility average PDPM case mix index calculated quarterly
and (ii) the regional wage adjuster, and then add the
Medicaid access adjustment as defined in (e-3) of this
Section. Transition rates for services provided between
July 1, 2022 and October 1, 2023 shall be the greater of
the PDPM nursing component per diem or:
(A) for the quarter beginning July 1, 2022, the
RUG-IV nursing component per diem;
(B) for the quarter beginning October 1, 2022, the
sum of the RUG-IV nursing component per diem
multiplied by 0.80 and the PDPM nursing component per
diem multiplied by 0.20;
(C) for the quarter beginning January 1, 2023, the
sum of the RUG-IV nursing component per diem
multiplied by 0.60 and the PDPM nursing component per

diem multiplied by 0.40;
(D) for the quarter beginning April 1, 2023, the
sum of the RUG-IV nursing component per diem
multiplied by 0.40 and the PDPM nursing component per
diem multiplied by 0.60;
(E) for the quarter beginning July 1, 2023, the
sum of the RUG-IV nursing component per diem
multiplied by 0.20 and the PDPM nursing component per
diem multiplied by 0.80; or
(F) for the quarter beginning October 1, 2023 and
each subsequent quarter, the transition rate shall end
and a nursing facility shall be paid 100% of the PDPM
nursing component per diem.
(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:
(A) on January 1, 2014 shall be the quotient of the
paragraph (1) divided by the sum calculated under
subparagraph (D) of paragraph (2); and
(B) on and after July 1, 2014 and until July 1,
2022, shall be the amount calculated under

subparagraph (A) of this paragraph (3) plus $1.76; and
.
(C) beginning July 1, 2022 and thereafter, $7
shall be added to the amount calculated under
subparagraph (B) of this paragraph (3) of this
Section.
(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) Beginning July 1, 2014, the Department shall allocate
funding in the amount up to $10,000,000 for per diem add-ons to
the RUGS methodology for dates of service on and after July 1,
2014:
(1) $0.63 for each resident who scores in I4200
Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
(2) $2.67 for each resident who scores either a "1" or
"2" in any items S1200A through S1200I and also scores in
RUG groups PA1, PA2, BA1, or BA2.
(e-1) (Blank).
(e-2) For dates of services beginning January 1, 2014 and

ending September 30, 2023, 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.

(e-3) A Medicaid Access Adjustment of $4 adjusted for the
facility average PDPM case mix index calculated quarterly
shall be added to the statewide PDPM nursing per diem for all
facilities with annual Medicaid bed days of at least 70% of all
occupied bed days adjusted quarterly. For each new calendar
year and for the 6-month period beginning July 1, 2022, the
percentage of a facility's occupied bed days comprised of
Medicaid bed days shall be determined by the Department
quarterly. This subsection shall be inoperative on and after
January 1, 2028.
(f) (Blank). 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) (Blank); 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) (Blank); 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%.
(i) On and after 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%.
(j) Notwithstanding any other provision of law, subject to
federal approval, effective July 1, 2019, sufficient funds
shall be allocated for changes to rates for facilities
licensed under the Nursing Home Care Act as skilled nursing
facilities or intermediate care facilities for dates of
services on and after July 1, 2019: (i) to establish, through
June 30, 2022 a per diem add-on to the direct care per diem
rate not to exceed $70,000,000 annually in the aggregate

taking into account federal matching funds for the purpose of
addressing the facility's unique staffing needs, adjusted
quarterly and distributed by a weighted formula based on
Medicaid bed days on the last day of the second quarter
preceding the quarter for which the rate is being adjusted.
Beginning July 1, 2022, the annual $70,000,000 described in
the preceding sentence shall be dedicated to the variable per
diem add-on for staffing under paragraph (6) of subsection
(d); and (ii) in an amount not to exceed $170,000,000 annually
in the aggregate taking into account federal matching funds to
permit the support component of the nursing facility rate to
be updated as follows:
(1) 80%, or $136,000,000, of the funds shall be used
to update each facility's rate in effect on June 30, 2019
using the most recent cost reports on file, which have had
a limited review conducted by the Department of Healthcare
and Family Services and will not hold up enacting the rate
increase, with the Department of Healthcare and Family
Services and taking into account subsection (i).
(2) After completing the calculation in paragraph (1),
any facility whose rate is less than the rate in effect on
June 30, 2019 shall have its rate restored to the rate in
effect on June 30, 2019 from the 20% of the funds set
aside.
(3) The remainder of the 20%, or $34,000,000, shall be
used to increase each facility's rate by an equal

percentage.
To implement item (i) in this subsection, facilities shall
file quarterly reports documenting compliance with its
annually approved staffing plan, which shall permit compliance
with Section 3-202.05 of the Nursing Home Care Act. A facility
that fails to meet the benchmarks and dates contained in the
plan may have its add-on adjusted in the quarter following the
quarterly review. Nothing in this Section shall limit the
ability of the facility to appeal a ruling of non-compliance
and a subsequent reduction to the add-on. Funds adjusted for
noncompliance shall be maintained in the Long-Term Care
Provider Fund and accounted for separately. At the end of each
fiscal year, these funds shall be made available to facilities
for special staffing projects.
In order to provide for the expeditious and timely
implementation of the provisions of Public Act 101-10,
emergency rules to implement any provision of Public Act
101-10 may be adopted in accordance with this subsection by
the agency charged with administering that provision or
initiative. The agency shall simultaneously file emergency
rules and permanent rules to ensure that there is no
interruption in administrative guidance. The 150-day
limitation of the effective period of emergency rules does not
apply to rules adopted under this subsection, and the
effective period may continue through June 30, 2021. The
24-month limitation on the adoption of emergency rules does

not apply to rules adopted under this subsection. The adoption
of emergency rules authorized by this subsection is deemed to
be necessary for the public interest, safety, and welfare.
(k) During the first quarter of State Fiscal Year 2020,
the Department of Healthcare of Family Services must convene a
technical advisory group consisting of members of all trade
associations representing Illinois skilled nursing providers
to discuss changes necessary with federal implementation of
Medicare's Patient-Driven Payment Model. Implementation of
Medicare's Patient-Driven Payment Model shall, by September 1,
2020, end the collection of the MDS data that is necessary to
maintain the current RUG-IV Medicaid payment methodology. The
technical advisory group must consider a revised reimbursement
methodology that takes into account transparency,
accountability, actual staffing as reported under the
federally required Payroll Based Journal system, changes to
the minimum wage, adequacy in coverage of the cost of care, and
a quality component that rewards quality improvements.
(l) The Department shall establish per diem add-on
payments to improve the quality of care delivered by
facilities, including:
(1) Incentive payments determined by facility
performance on specified quality measures in an initial
amount of $70,000,000. Nothing in this subsection shall be
construed to limit the quality of care payments in the
aggregate statewide to $70,000,000, and, if quality of

care has improved across nursing facilities, the
Department shall adjust those add-on payments accordingly.
The quality payment methodology described in this
subsection must be used for at least State Fiscal Year
2023. Beginning with the quarter starting July 1, 2023,
the Department may add, remove, or change quality metrics
and make associated changes to the quality payment
methodology as outlined in subparagraph (E). Facilities
designated by the Centers for Medicare and Medicaid
Services as a special focus facility or a hospital-based
nursing home do not qualify for quality payments.
(A) Each quality pool must be distributed by
assigning a quality weighted score for each nursing
home which is calculated by multiplying the nursing
home's quality base period Medicaid days by the
nursing home's star rating weight in that period.
(B) Star rating weights are assigned based on the
nursing home's star rating for the LTS quality star
rating. As used in this subparagraph, "LTS quality
star rating" means the long-term stay quality rating
for each nursing facility, as assigned by the Centers
for Medicare and Medicaid Services under the Five-Star
Quality Rating System. The rating is a number ranging
from 0 (lowest) to 5 (highest).
(i) Zero-star or one-star rating has a weight
of 0.

(ii) Two-star rating has a weight of 0.75.
(iii) Three-star rating has a weight of 1.5.
(iv) Four-star rating has a weight of 2.5.
(v) Five-star rating has a weight of 3.5.
(C) Each nursing home's quality weight score is
divided by the sum of all quality weight scores for
qualifying nursing homes to determine the proportion
of the quality pool to be paid to the nursing home.
(D) The quality pool is no less than $70,000,000
annually or $17,500,000 per quarter. The Department
shall publish on its website the estimated payments
and the associated weights for each facility 45 days
prior to when the initial payments for the quarter are
to be paid. The Department shall assign each facility
the most recent and applicable quarter's STAR value
unless the facility notifies the Department within 15
days of an issue and the facility provides reasonable
evidence demonstrating its timely compliance with
federal data submission requirements for the quarter
of record. If such evidence cannot be provided to the
Department, the STAR rating assigned to the facility
shall be reduced by one from the prior quarter.
(E) The Department shall review quality metrics
used for payment of the quality pool and make
recommendations for any associated changes to the
methodology for distributing quality pool payments in

consultation with associations representing long-term
care providers, consumer advocates, organizations
representing workers of long-term care facilities, and
payors. The Department may establish, by rule, changes
to the methodology for distributing quality pool
payments.
(F) The Department shall disburse quality pool
payments from the Long-Term Care Provider Fund on a
monthly basis in amounts proportional to the total
quality pool payment determined for the quarter.
(G) The Department shall publish any changes in
the methodology for distributing quality pool payments
prior to the beginning of the measurement period or
quality base period for any metric added to the
distribution's methodology.
(2) Payments based on CNA tenure, promotion, and CNA
training for the purpose of increasing CNA compensation.
It is the intent of this subsection that payments made in
accordance with this paragraph be directly incorporated
into increased compensation for CNAs. As used in this
paragraph, "CNA" means a certified nursing assistant as
that term is described in Section 3-206 of the Nursing
Home Care Act, Section 3-206 of the ID/DD Community Care
Act, and Section 3-206 of the MC/DD Act. The Department
shall establish, by rule, payments to nursing facilities
equal to Medicaid's share of the tenure wage increments

specified in this paragraph for all reported CNA employee
hours compensated according to a posted schedule
consisting of increments at least as large as those
specified in this paragraph. The increments are as
follows: an additional $1.50 per hour for CNAs with at
least one and less than 2 years' experience plus another
$1 per hour for each additional year of experience up to a
maximum of $6.50 for CNAs with at least 6 years of
experience. For purposes of this paragraph, Medicaid's
share shall be the ratio determined by paid Medicaid bed
days divided by total bed days for the applicable time
period used in the calculation. In addition, and additive
to any tenure increments paid as specified in this
paragraph, the Department shall establish, by rule,
payments supporting Medicaid's share of the
promotion-based wage increments for CNA employee hours
compensated for that promotion with at least a $1.50
hourly increase. Medicaid's share shall be established as
it is for the tenure increments described in this
paragraph. Qualifying promotions shall be defined by the
Department in rules for an expected 10-15% subset of CNAs
assigned intermediate, specialized, or added roles such as
CNA trainers, CNA scheduling "captains", and CNA
specialists for resident conditions like dementia or
memory care or behavioral health.
(m) The Department shall work with nursing facility

industry representatives to design policies and procedures to
permit facilities to address the integrity of data from
federal reporting sites used by the Department in setting
facility rates.
(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
102-77, eff. 7-9-21; 102-558, eff. 8-20-21.)
(305 ILCS 5/5-5.8) (from Ch. 23, par. 5-5.8)
Sec. 5-5.8. Report on nursing home reimbursement. The
Illinois Department shall report annually to the General
Assembly, no later than the first Monday in April of 1982, and
each year thereafter, in regard to:
(a) the rate structure used by the Illinois Department
to reimburse nursing facilities;
(b) changes in the rate structure for reimbursing
nursing facilities;
(c) the administrative and program costs of
reimbursing nursing facilities;
(d) the availability of beds in nursing facilities for
public aid recipients; and
(e) the number of closings of nursing facilities, and
the reasons for those closings; and .
(f) for years beginning 2025 and thereafter, drawing
on all available information that evaluates, to the extent
possible, nursing facility costs and revenue, including a
focus on the period of initial implementation of the

payments and programs authorized in this Act.
The requirement for reporting to the General Assembly
shall be satisfied by filing copies of the report as required
by Section 3.1 of the General Assembly Organization Act, and
filing such additional copies with the State Government Report
Distribution Center for the General Assembly as is required
under paragraph (t) of Section 7 of the State Library Act.
(Source: P.A. 100-1148, eff. 12-10-18.)
(305 ILCS 5/5B-2) (from Ch. 23, par. 5B-2)
Sec. 5B-2. Assessment; no local authorization to tax.
(a) For the privilege of engaging in the occupation of
long-term care provider, beginning July 1, 2011 through June
30, 2022, or upon federal approval by the Centers for Medicare
and Medicaid Services of the long-term care provider
assessment described in subsection (a-1), whichever is later,
an assessment is imposed upon each long-term care provider in
an amount equal to $6.07 times the number of occupied bed days
due and payable each month. Notwithstanding any provision of
any other Act to the contrary, this assessment shall be
construed as a tax, but shall not be billed or passed on to any
resident of a nursing home operated by the nursing home
provider.
(a-1) For the privilege of engaging in the occupation of
long-term care provider for each occupied non-Medicare bed
day, beginning July 1, 2022, an assessment is imposed upon

each long-term care provider in an amount varying with the
number of paid Medicaid resident days per annum in the
facility with the following schedule of occupied bed tax
amounts. This assessment is due and payable each month. The
tax shall follow the schedule below and be rebased by the
Department on an annual basis. The Department shall publish
each facility's rebased tax rate according to the schedule in
this Section 30 days prior to the beginning of the 6-month
period beginning July 1, 2022 and thereafter 30 days prior to
the beginning of each calendar year which shall incorporate
the number of paid Medicaid days used to determine each
facility's rebased tax rate.
(1) 0-5,000 paid Medicaid resident days per annum,
$10.67.
(2) 5,001-15,000 paid Medicaid resident days per
annum, $19.20.
(3) 15,001-35,000 paid Medicaid resident days per
annum, $22.40.
(4) 35,001-55,000 paid Medicaid resident days per
annum, $19.20.
(5) 55,001-65,000 paid Medicaid resident days per
annum, $13.86.
(6) 65,001+ paid Medicaid resident days per annum,
$10.67.
(7) Any non-profit nursing facilities without
Medicaid-certified beds, $7 per occupied bed day.

Notwithstanding any provision of any other Act to the
contrary, this assessment shall be construed as a tax but
shall not be billed or passed on to any resident of a nursing
home operated by the nursing home provider.
For each new calendar year and for the 6-month period
beginning July 1, 2022, a facility's paid Medicaid resident
days per annum shall be determined using the Department's
Medicaid Management Information System to include Medicaid
resident days for the year ending 9 months earlier.
(b) Nothing in this amendatory Act of 1992 shall be
construed to authorize any home rule unit or other unit of
local government to license for revenue or impose a tax or
assessment upon long-term care providers or the occupation of
long-term care provider, or a tax or assessment measured by
the income or earnings or occupied bed days of a long-term care
provider.
(c) The assessment imposed by this Section shall not be
due and payable, however, until after the Department notifies
the long-term care providers, in writing, that the payment
methodologies to long-term care providers required under
Section 5-5.2 5-5.4 of this Code have been approved by the
Centers for Medicare and Medicaid Services of the U.S.
Department of Health and Human Services and that the waivers
under 42 CFR 433.68 for the assessment imposed by this
Section, if necessary, have been granted by the Centers for
Medicare and Medicaid Services of the U.S. Department of

Health and Human Services.
(Source: P.A. 96-1530, eff. 2-16-11; 97-10, eff. 6-14-11;
97-584, eff. 8-26-11.)
(305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)
Sec. 5B-4. Payment of assessment; penalty.
(a) The assessment imposed by Section 5B-2 shall be due
and payable monthly, on the last State business day of the
month for occupied bed days reported for the preceding third
month prior to the month in which the tax is payable and due. A
facility that has delayed payment due to the State's failure
to reimburse for services rendered may request an extension on
the due date for payment pursuant to subsection (b) and shall
pay the assessment within 30 days of reimbursement by the
Department. The Illinois Department may provide that county
nursing homes directed and maintained pursuant to Section
5-1005 of the Counties Code may meet their assessment
obligation by certifying to the Illinois Department that
county expenditures have been obligated for the operation of
the county nursing home in an amount at least equal to the
amount of the assessment.
(a-5) The Illinois Department shall provide for an
electronic submission process for each long-term care facility
to report at a minimum the number of occupied bed days of the
long-term care facility for the reporting period and other
reasonable information the Illinois Department requires for

the administration of its responsibilities under this Code.
Beginning July 1, 2013, a separate electronic submission shall
be completed for each long-term care facility in this State
operated by a long-term care provider. The Illinois Department
shall provide a self-reporting notice of the assessment form
that the long-term care facility completes for the required
period and submits with its assessment payment to the Illinois
Department. To the extent practicable, the Department shall
coordinate the assessment reporting requirements with other
reporting required of long-term care facilities.
(b) The Illinois Department is authorized to establish
delayed payment schedules for long-term care providers that
are unable to make assessment payments when due under this
Section due to financial difficulties, as determined by the
Illinois Department. The Illinois Department may not deny a
request for delay of payment of the assessment imposed under
this Article if the long-term care provider has not been paid
by the State or the Medicaid managed care organization for
services provided during the month on which the assessment is
levied or the Medicaid managed care organization has not been
paid by the State.
(c) If a long-term care provider fails to pay the full
amount of an assessment payment when due (including any
extensions granted under subsection (b)), there shall, unless
waived by the Illinois Department for reasonable cause, be
added to the assessment imposed by Section 5B-2 a penalty

assessment equal to the lesser of (i) 5% of the amount of the
assessment payment not paid on or before the due date plus 5%
of the portion thereof remaining unpaid on the last day of each
month thereafter or (ii) 100% of the assessment payment amount
not paid on or before the due date. For purposes of this
subsection, payments will be credited first to unpaid
assessment payment amounts (rather than to penalty or
interest), beginning with the most delinquent assessment
payments. Payment cycles of longer than 60 days shall be one
factor the Director takes into account in granting a waiver
under this Section.
(c-5) If a long-term care facility fails to file its
assessment bill with payment, there shall, unless waived by
the Illinois Department for reasonable cause, be added to the
assessment due a penalty assessment equal to 25% of the
assessment due. After July 1, 2013, no penalty shall be
assessed under this Section if the Illinois Department does
not provide a process for the electronic submission of the
information required by subsection (a-5).
(d) Nothing in this amendatory Act of 1993 shall be
construed to prevent the Illinois Department from collecting
all amounts due under this Article pursuant to an assessment
imposed before the effective date of this amendatory Act of
1993.
(e) Nothing in this amendatory Act of the 96th General
Assembly shall be construed to prevent the Illinois Department

from collecting all amounts due under this Code pursuant to an
assessment, tax, fee, or penalty imposed before the effective
date of this amendatory Act of the 96th General Assembly.
(f) No installment of the assessment imposed by Section
5B-2 shall be due and payable until after the Department
notifies the long-term care providers, in writing, that the
payment methodologies to long-term care providers required
under Section 5-5.2 5-5.4 of this Code have been approved by
the Centers for Medicare and Medicaid Services of the U.S.
Department of Health and Human Services and the waivers under
42 CFR 433.68 for the assessment imposed by this Section, if
necessary, have been granted by the Centers for Medicare and
Medicaid Services of the U.S. Department of Health and Human
Services. Upon notification to the Department of approval of
the payment methodologies required under Section 5-5.2 5-5.4
of this Code and the waivers granted under 42 CFR 433.68, all
installments otherwise due under Section 5B-4 prior to the
date of notification shall be due and payable to the
Department upon written direction from the Department within
90 days after issuance by the Comptroller of the payments
required under Section 5-5.2 5-5.4 of this Code.
(Source: P.A. 100-501, eff. 6-1-18; 101-649, eff. 7-7-20.)
(305 ILCS 5/5B-5) (from Ch. 23, par. 5B-5)
Sec. 5B-5. Annual reporting; penalty; maintenance of
records.

(a) After December 31 of each year, and on or before March
31 of the succeeding year, every long-term care provider
subject to assessment under this Article shall file a report
with the Illinois Department. The report shall be in a form and
manner prescribed by the Illinois Department and shall state
the revenue received by the long-term care provider, reported
in such categories as may be required by the Illinois
Department, and other reasonable information the Illinois
Department requires for the administration of its
responsibilities under this Code.
(b) If a long-term care provider operates or maintains
more than one long-term care facility in this State, the
provider may not file a single return covering all those
long-term care facilities, but shall file a separate return
for each long-term care facility and shall compute and pay the
assessment for each long-term care facility separately.
(c) Notwithstanding any other provision in this Article,
in the case of a person who ceases to operate or maintain a
long-term care facility in respect of which the person is
subject to assessment under this Article as a long-term care
provider, the person shall file a final, amended return with
the Illinois Department not more than 90 days after the
cessation reflecting the adjustment and shall pay with the
final return the assessment for the year as so adjusted (to the
extent not previously paid). If a person fails to file a final
amended return on a timely basis, there shall, unless waived

by the Illinois Department for reasonable cause, be added to
the assessment due a penalty assessment equal to 25% of the
assessment due.
(d) Notwithstanding any other provision of this Article, a
provider who commences operating or maintaining a long-term
care facility that was under a prior ownership and remained
licensed by the Department of Public Health shall notify the
Illinois Department of any the change in ownership regardless
of percentage, and shall be responsible to immediately pay any
prior amounts owed by the facility. In addition, beginning
January 1, 2023, all providers operating or maintaining a
long-term care facility shall notify the Illinois Department
of all individual owners and any individuals or organizations
that are part of a limited liability company with ownership of
that facility and the percentage ownership of each owner. This
ownership reporting requirement does not include individual
shareholders in a publicly held corporation. Submission of the
information as part of the Department's cost reporting
requirements shall satisfy this requirement.
(e) The Department shall develop a procedure for sharing
with a potential buyer of a facility information regarding
outstanding assessments and penalties owed by that facility.
(f) In the case of a long-term care provider existing as a
corporation or legal entity other than an individual, the
return filed by it shall be signed by its president,
vice-president, secretary, or treasurer or by its properly

authorized agent.
(g) If a long-term care provider fails to file its return
on or before the due date of the return, there shall, unless
waived by the Illinois Department for reasonable cause, be
added to the assessment imposed by Section 5B-2 a penalty
assessment equal to 25% of the assessment imposed for the
year. After July 1, 2013, no penalty shall be assessed if the
Illinois Department has not established a process for the
electronic submission of information.
(h) Every long-term care provider subject to assessment
under this Article shall keep records and books that will
permit the determination of occupied bed days on a calendar
year basis. All such books and records shall be kept in the
English language and shall, at all times during business hours
of the day, be subject to inspection by the Illinois
Department or its duly authorized agents and employees.
(i) The Illinois Department shall establish a process for
long-term care providers to electronically submit all
information required by this Section no later than July 1,
2013.
(Source: P.A. 96-1530, eff. 2-16-11; 97-403, eff. 1-1-12;
97-813, eff. 7-13-12.)
(305 ILCS 5/5B-8) (from Ch. 23, par. 5B-8)
Sec. 5B-8. Long-Term Care Provider Fund.
(a) There is created in the State Treasury the Long-Term

Care Provider Fund. Interest earned by the Fund shall be
credited to the Fund. The Fund shall not be used to replace any
moneys appropriated to the Medicaid program by the General
Assembly.
(b) The Fund is created for the purpose of receiving and
disbursing moneys in accordance with this Article.
Disbursements from the Fund shall be made only as follows:
(1) For payments to nursing facilities, including
county nursing facilities but excluding State-operated
facilities, under Title XIX of the Social Security Act and
Article V of this Code.
(1.5) For payments to managed care organizations as
defined in Section 5-30.1 of this Code.
(2) For the reimbursement of moneys collected by the
Illinois Department through error or mistake.
(3) For payment of administrative expenses incurred by
the Illinois Department or its agent in performing the
activities authorized by this Article.
(3.5) For reimbursement of expenses incurred by
long-term care facilities, and payment of administrative
expenses incurred by the Department of Public Health, in
relation to the conduct and analysis of background checks
for identified offenders under the Nursing Home Care Act.
(4) For payments of any amounts that are reimbursable
to the federal government for payments from this Fund that
are required to be paid by State warrant.

(5) For making transfers to the General Obligation
Bond Retirement and Interest Fund, as those transfers are
authorized in the proceedings authorizing debt under the
Short Term Borrowing Act, but transfers made under this
paragraph (5) shall not exceed the principal amount of
debt issued in anticipation of the receipt by the State of
moneys to be deposited into the Fund.
(6) For making transfers, at the direction of the
Director of the Governor's Office of Management and Budget
during each fiscal year beginning on or after July 1,
2011, to other State funds in an annual amount of
$20,000,000 of the tax collected pursuant to this Article
for the purpose of enforcement of nursing home standards,
support of the ombudsman program, and efforts to expand
home and community-based services. No transfer under this
paragraph shall occur until (i) the payment methodologies
created by Public Act 96-1530 under Section 5-5.4 of this
Code have been approved by the Centers for Medicare and
Medicaid Services of the U.S. Department of Health and
Human Services and (ii) the assessment imposed by Section
5B-2 of this Code is determined to be a permissible tax
under Title XIX of the Social Security Act.
Disbursements from the Fund, other than transfers made
pursuant to paragraphs (5) and (6) of this subsection, shall
be by warrants drawn by the State Comptroller upon receipt of
vouchers duly executed and certified by the Illinois

Department.
(c) The Fund shall consist of the following:
(1) All moneys collected or received by the Illinois
Department from the long-term care provider assessment
imposed by this Article.
(2) All federal matching funds received by the
Illinois Department as a result of expenditures made from
the Fund by the Illinois Department that are attributable
to moneys deposited in the Fund.
(3) Any interest or penalty levied in conjunction with
the administration of this Article.
(4) (Blank).
(5) All other monies received for the Fund from any
other source, including interest earned thereon.
(Source: P.A. 96-1530, eff. 2-16-11; 97-584, eff. 8-26-11.)
(305 ILCS 5/5E-10)
Sec. 5E-10. Fee. Through June 30, 2022 or upon federal
approval by the Centers for Medicare and Medicaid Services of
the long-term care provider assessment described in subsection
(a-1) of Section 5B-2 of this Code, whichever is later, every
Every nursing home provider shall pay to the Illinois
Department, on or before September 10, December 10, March 10,
and June 10, a fee in the amount of $1.50 for each licensed
nursing bed day for the calendar quarter in which the payment
is due. This fee shall not be billed or passed on to any

resident of a nursing home operated by the nursing home
provider. All fees received by the Illinois Department under
this Section shall be deposited into the Long-Term Care
Provider Fund.
(Source: P.A. 88-88; 89-21, eff. 7-1-95.)
(305 ILCS 5/5E-20 new)
Sec. 5E-20. Repealer. This Article 5E is repealed on July
1, 2024.