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| Public Act 098-0727
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| HB4600 Enrolled | LRB098 17867 KTG 52991 b |
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AN ACT concerning public aid.
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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 5. The Illinois Public Aid Code is amended by |
changing Section 5-5.2 as follows:
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(305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
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Sec. 5-5.2. Payment.
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(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.
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(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.
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(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, |
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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 |
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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 |
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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 |
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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 |
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(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 |
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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.)
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Section 99. Effective date. This Act takes effect upon |
becoming law.
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