Bill Text: IL SB0110 | 2021-2022 | 102nd General Assembly | Engrossed
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Reinserts the provisions of the introduced bill, but with the following change: provides that, in applying the regional wage adjuster component of the RUG-IV 48 reimbursement methodology, no adjuster shall be lower than 1.0 (rather than 0.95). Effective immediately.
Spectrum: Moderate Partisan Bill (Democrat 16-4)
Status: (Passed) 2021-07-09 - Public Act . . . . . . . . . 102-0077 [SB0110 Detail]
Download: Illinois-2021-SB0110-Engrossed.html
Bill Title: Reinserts the provisions of the introduced bill, but with the following change: provides that, in applying the regional wage adjuster component of the RUG-IV 48 reimbursement methodology, no adjuster shall be lower than 1.0 (rather than 0.95). Effective immediately.
Spectrum: Moderate Partisan Bill (Democrat 16-4)
Status: (Passed) 2021-07-09 - Public Act . . . . . . . . . 102-0077 [SB0110 Detail]
Download: Illinois-2021-SB0110-Engrossed.html
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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Section 5-5.2 as follows:
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6 | (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
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7 | Sec. 5-5.2. Payment.
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8 | (a) All nursing facilities that are grouped pursuant to | ||||||
9 | Section
5-5.1 of this Act shall receive the same rate of | ||||||
10 | payment for similar
services.
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11 | (b) It shall be a matter of State policy that the Illinois | ||||||
12 | Department
shall utilize a uniform billing cycle throughout | ||||||
13 | the State for the
long-term care providers.
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14 | (c) Notwithstanding any other provisions of this Code, the | ||||||
15 | methodologies for reimbursement of nursing services as | ||||||
16 | provided under this Article shall no longer be applicable for | ||||||
17 | bills payable for nursing services rendered on or after a new | ||||||
18 | reimbursement system based on the Resource Utilization Groups | ||||||
19 | (RUGs) has been fully operationalized, which shall take effect | ||||||
20 | for services provided on or after January 1, 2014. | ||||||
21 | (d) The new nursing services reimbursement methodology | ||||||
22 | utilizing RUG-IV 48 grouper model, which shall be referred to | ||||||
23 | as the RUGs reimbursement system, taking effect January 1, |
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1 | 2014, shall be based on the following: | ||||||
2 | (1) The methodology shall be resident-driven, | ||||||
3 | facility-specific, and cost-based. | ||||||
4 | (2) Costs shall be annually rebased and case mix index | ||||||
5 | quarterly updated. The nursing services methodology will | ||||||
6 | be assigned to the Medicaid enrolled residents on record | ||||||
7 | as of 30 days prior to the beginning of the rate period in | ||||||
8 | the Department's Medicaid Management Information System | ||||||
9 | (MMIS) as present on the last day of the second quarter | ||||||
10 | preceding the rate period based upon the Assessment | ||||||
11 | Reference Date of the Minimum Data Set (MDS). | ||||||
12 | (3) Regional wage adjustors based on the Health | ||||||
13 | Service Areas (HSA) groupings and adjusters in effect on | ||||||
14 | April 30, 2012 shall be included , except no adjuster shall | ||||||
15 | be lower than 1.0 . | ||||||
16 | (4) Case mix index shall be assigned to each resident | ||||||
17 | class based on the Centers for Medicare and Medicaid | ||||||
18 | Services staff time measurement study in effect on July 1, | ||||||
19 | 2013, utilizing an index maximization approach. | ||||||
20 | (5) The pool of funds available for distribution by | ||||||
21 | case mix and the base facility rate shall be determined | ||||||
22 | using the formula contained in subsection (d-1). | ||||||
23 | (d-1) Calculation of base year Statewide RUG-IV nursing | ||||||
24 | base per diem rate. | ||||||
25 | (1) Base rate spending pool shall be: | ||||||
26 | (A) The base year resident days which are |
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1 | calculated by multiplying the number of Medicaid | ||||||
2 | residents in each nursing home as indicated in the MDS | ||||||
3 | data defined in paragraph (4) by 365. | ||||||
4 | (B) Each facility's nursing component per diem in | ||||||
5 | effect on July 1, 2012 shall be multiplied by | ||||||
6 | subsection (A). | ||||||
7 | (C) Thirteen million is added to the product of | ||||||
8 | subparagraph (A) and subparagraph (B) to adjust for | ||||||
9 | the exclusion of nursing homes defined in paragraph | ||||||
10 | (5). | ||||||
11 | (2) For each nursing home with Medicaid residents as | ||||||
12 | indicated by the MDS data defined in paragraph (4), | ||||||
13 | weighted days adjusted for case mix and regional wage | ||||||
14 | adjustment shall be calculated. For each home this | ||||||
15 | calculation is the product of: | ||||||
16 | (A) Base year resident days as calculated in | ||||||
17 | subparagraph (A) of paragraph (1). | ||||||
18 | (B) The nursing home's regional wage adjustor | ||||||
19 | based on the Health Service Areas (HSA) groupings and | ||||||
20 | adjustors in effect on April 30, 2012. | ||||||
21 | (C) Facility weighted case mix which is the number | ||||||
22 | of Medicaid residents as indicated by the MDS data | ||||||
23 | defined in paragraph (4) multiplied by the associated | ||||||
24 | case weight for the RUG-IV 48 grouper model using | ||||||
25 | standard RUG-IV procedures for index maximization. | ||||||
26 | (D) The sum of the products calculated for each |
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1 | nursing home in subparagraphs (A) through (C) above | ||||||
2 | shall be the base year case mix, rate adjusted | ||||||
3 | weighted days. | ||||||
4 | (3) The Statewide RUG-IV nursing base per diem rate: | ||||||
5 | (A) on January 1, 2014 shall be the quotient of the | ||||||
6 | paragraph (1) divided by the sum calculated under | ||||||
7 | subparagraph (D) of paragraph (2); and | ||||||
8 | (B) on and after July 1, 2014, shall be the amount | ||||||
9 | calculated under subparagraph (A) of this paragraph | ||||||
10 | (3) plus $1.76. | ||||||
11 | (4) Minimum Data Set (MDS) comprehensive assessments | ||||||
12 | for Medicaid residents on the last day of the quarter used | ||||||
13 | to establish the base rate. | ||||||
14 | (5) Nursing facilities designated as of July 1, 2012 | ||||||
15 | by the Department as "Institutions for Mental Disease" | ||||||
16 | shall be excluded from all calculations under this | ||||||
17 | subsection. The data from these facilities shall not be | ||||||
18 | used in the computations described in paragraphs (1) | ||||||
19 | through (4) above to establish the base rate. | ||||||
20 | (e) Beginning July 1, 2014, the Department shall allocate | ||||||
21 | funding in the amount up to $10,000,000 for per diem add-ons to | ||||||
22 | the RUGS methodology for dates of service on and after July 1, | ||||||
23 | 2014: | ||||||
24 | (1) $0.63 for each resident who scores in I4200 | ||||||
25 | Alzheimer's Disease or I4800 non-Alzheimer's Dementia. | ||||||
26 | (2) $2.67 for each resident who scores either a "1" or |
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1 | "2" in any items S1200A through S1200I and also scores in | ||||||
2 | RUG groups PA1, PA2, BA1, or BA2. | ||||||
3 | (e-1) (Blank). | ||||||
4 | (e-2) For dates of services beginning January 1, 2014, the | ||||||
5 | RUG-IV nursing component per diem for a nursing home shall be | ||||||
6 | the product of the statewide RUG-IV nursing base per diem | ||||||
7 | rate, the facility average case mix index, and the regional | ||||||
8 | wage adjustor. Transition rates for services provided between | ||||||
9 | January 1, 2014 and December 31, 2014 shall be as follows: | ||||||
10 | (1) The transition RUG-IV per diem nursing rate for | ||||||
11 | nursing homes whose rate calculated in this subsection | ||||||
12 | (e-2) is greater than the nursing component rate in effect | ||||||
13 | July 1, 2012 shall be paid the sum of: | ||||||
14 | (A) The nursing component rate in effect July 1, | ||||||
15 | 2012; plus | ||||||
16 | (B) The difference of the RUG-IV nursing component | ||||||
17 | per diem calculated for the current quarter minus the | ||||||
18 | nursing component rate in effect July 1, 2012 | ||||||
19 | multiplied by 0.88. | ||||||
20 | (2) The transition RUG-IV per diem nursing rate for | ||||||
21 | nursing homes whose rate calculated in this subsection | ||||||
22 | (e-2) is less than the nursing component rate in effect | ||||||
23 | July 1, 2012 shall be paid the sum of: | ||||||
24 | (A) The nursing component rate in effect July 1, | ||||||
25 | 2012; plus | ||||||
26 | (B) The difference of the RUG-IV nursing component |
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1 | per diem calculated for the current quarter minus the | ||||||
2 | nursing component rate in effect July 1, 2012 | ||||||
3 | multiplied by 0.13. | ||||||
4 | (f) Notwithstanding any other provision of this Code, on | ||||||
5 | and after July 1, 2012, reimbursement rates associated with | ||||||
6 | the nursing or support components of the current nursing | ||||||
7 | facility rate methodology shall not increase beyond the level | ||||||
8 | effective May 1, 2011 until a new reimbursement system based | ||||||
9 | on the RUGs IV 48 grouper model has been fully | ||||||
10 | operationalized. | ||||||
11 | (g) Notwithstanding any other provision of this Code, on | ||||||
12 | and after July 1, 2012, for facilities not designated by the | ||||||
13 | Department of Healthcare and Family Services as "Institutions | ||||||
14 | for Mental Disease", rates effective May 1, 2011 shall be | ||||||
15 | adjusted as follows: | ||||||
16 | (1) Individual nursing rates for residents classified | ||||||
17 | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | ||||||
18 | ending March 31, 2012 shall be reduced by 10%; | ||||||
19 | (2) Individual nursing rates for residents classified | ||||||
20 | in all other RUG IV groups shall be reduced by 1.0%; | ||||||
21 | (3) Facility rates for the capital and support | ||||||
22 | components shall be reduced by 1.7%. | ||||||
23 | (h) Notwithstanding any other provision of this Code, on | ||||||
24 | and after July 1, 2012, nursing facilities designated by the | ||||||
25 | Department of Healthcare and Family Services as "Institutions | ||||||
26 | for Mental Disease" and "Institutions for Mental Disease" that |
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1 | are facilities licensed under the Specialized Mental Health | ||||||
2 | Rehabilitation Act of 2013 shall have the nursing, | ||||||
3 | socio-developmental, capital, and support components of their | ||||||
4 | reimbursement rate effective May 1, 2011 reduced in total by | ||||||
5 | 2.7%. | ||||||
6 | (i) On and after July 1, 2014, the reimbursement rates for | ||||||
7 | the support component of the nursing facility rate for | ||||||
8 | facilities licensed under the Nursing Home Care Act as skilled | ||||||
9 | or intermediate care facilities shall be the rate in effect on | ||||||
10 | June 30, 2014 increased by 8.17%. | ||||||
11 | (j) Notwithstanding any other provision of law, subject to | ||||||
12 | federal approval, effective July 1, 2019, sufficient funds | ||||||
13 | shall be allocated for changes to rates for facilities | ||||||
14 | licensed under the Nursing Home Care Act as skilled nursing | ||||||
15 | facilities or intermediate care facilities for dates of | ||||||
16 | services on and after July 1, 2019: (i) to establish a per diem | ||||||
17 | add-on to the direct care per diem rate not to exceed | ||||||
18 | $70,000,000 annually in the aggregate taking into account | ||||||
19 | federal matching funds for the purpose of addressing the | ||||||
20 | facility's unique staffing needs, adjusted quarterly and | ||||||
21 | distributed by a weighted formula based on Medicaid bed days | ||||||
22 | on the last day of the second quarter preceding the quarter for | ||||||
23 | which the rate is being adjusted; and (ii) in an amount not to | ||||||
24 | exceed $170,000,000 annually in the aggregate taking into | ||||||
25 | account federal matching funds to permit the support component | ||||||
26 | of the nursing facility rate to be updated as follows: |
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1 | (1) 80%, or $136,000,000, of the funds shall be used | ||||||
2 | to update each facility's rate in effect on June 30, 2019 | ||||||
3 | using the most recent cost reports on file, which have had | ||||||
4 | a limited review conducted by the Department of Healthcare | ||||||
5 | and Family Services and will not hold up enacting the rate | ||||||
6 | increase, with the Department of Healthcare and Family | ||||||
7 | Services and taking into account subsection (i). | ||||||
8 | (2) After completing the calculation in paragraph (1), | ||||||
9 | any facility whose rate is less than the rate in effect on | ||||||
10 | June 30, 2019 shall have its rate restored to the rate in | ||||||
11 | effect on June 30, 2019 from the 20% of the funds set | ||||||
12 | aside. | ||||||
13 | (3) The remainder of the 20%, or $34,000,000, shall be | ||||||
14 | used to increase each facility's rate by an equal | ||||||
15 | percentage. | ||||||
16 | To implement item (i) in this subsection, facilities shall | ||||||
17 | file quarterly reports documenting compliance with its | ||||||
18 | annually approved staffing plan, which shall permit compliance | ||||||
19 | with Section 3-202.05 of the Nursing Home Care Act. A facility | ||||||
20 | that fails to meet the benchmarks and dates contained in the | ||||||
21 | plan may have its add-on adjusted in the quarter following the | ||||||
22 | quarterly review. Nothing in this Section shall limit the | ||||||
23 | ability of the facility to appeal a ruling of non-compliance | ||||||
24 | and a subsequent reduction to the add-on. Funds adjusted for | ||||||
25 | noncompliance shall be maintained in the Long-Term Care | ||||||
26 | Provider Fund and accounted for separately. At the end of each |
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1 | fiscal year, these funds shall be made available to facilities | ||||||
2 | for special staffing projects. | ||||||
3 | In order to provide for the expeditious and timely
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4 | implementation of the provisions of Public Act 101-10 this | ||||||
5 | amendatory Act of the
101st General Assembly , emergency rules | ||||||
6 | to implement any provision of Public Act 101-10 this | ||||||
7 | amendatory Act of the 101st General Assembly may be adopted in | ||||||
8 | accordance with this subsection by the agency charged with | ||||||
9 | administering that provision or
initiative. The agency shall | ||||||
10 | simultaneously file emergency rules and permanent rules to | ||||||
11 | ensure that there is no interruption in administrative | ||||||
12 | guidance. The 150-day limitation of the effective period of | ||||||
13 | emergency rules does not apply to rules adopted under this
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14 | subsection, and the effective period may continue through
June | ||||||
15 | 30, 2021. The 24-month limitation on the adoption of
emergency | ||||||
16 | rules does not apply to rules adopted under this
subsection. | ||||||
17 | The adoption of emergency rules authorized by this subsection | ||||||
18 | is deemed to be necessary for the public interest, safety, and | ||||||
19 | welfare. | ||||||
20 | (k) (j) During the first quarter of State Fiscal Year | ||||||
21 | 2020, the Department of Healthcare of Family Services must | ||||||
22 | convene a technical advisory group consisting of members of | ||||||
23 | all trade associations representing Illinois skilled nursing | ||||||
24 | providers to discuss changes necessary with federal | ||||||
25 | implementation of Medicare's Patient-Driven Payment Model. | ||||||
26 | Implementation of Medicare's Patient-Driven Payment Model |
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1 | shall, by September 1, 2020, end the collection of the MDS data | ||||||
2 | that is necessary to maintain the current RUG-IV Medicaid | ||||||
3 | payment methodology. The technical advisory group must | ||||||
4 | consider a revised reimbursement methodology that takes into | ||||||
5 | account transparency, accountability, actual staffing as | ||||||
6 | reported under the federally required Payroll Based Journal | ||||||
7 | system, changes to the minimum wage, adequacy in coverage of | ||||||
8 | the cost of care, and a quality component that rewards quality | ||||||
9 | improvements. | ||||||
10 | (Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19; | ||||||
11 | revised 9-18-19.)
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12 | Section 99. Effective date. This Act takes effect upon | ||||||
13 | becoming law.
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