Bill Text: IL SB0741 | 2013-2014 | 98th General Assembly | Amended

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Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning notice to the circuit clerk of support payments received by the Department of Public Aid.

Spectrum: Partisan Bill (Democrat 42-2)

Status: (Passed) 2014-06-16 - Public Act . . . . . . . . . 98-0651 [SB0741 Detail]

Download: Illinois-2013-SB0741-Amended.html

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Sen. Donne E. Trotter

Filed: 3/26/2014

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AMENDMENT TO SENATE BILL 741
AMENDMENT NO. ______. Amend Senate Bill 741 by replacing
everything after the enacting clause with the following:
"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

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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.
(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

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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

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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).
(3-1) Beginning January 1, 2015 and every quarter
thereafter, the base per diem rate set by the calculations
contained in this Section, which is $83.49, shall be
adjusted by the addition of the quotient of $32,000,000 set
aside for this purpose and any additional moneys as
provided in paragraph (4) of subsection (e) and subsection
(e-3) divided by the sum calculated under subparagraph (D)
of paragraph (2).
(4) Minimum Data Set (MDS) comprehensive assessments
for Medicaid residents on March 31, 2012 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

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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 which shall establish at a minimum the
following add-on adjustments to the facility's RUG-IV rate: .
(1) at a minimum a $208 per day add-on for each
resident qualifying for ventilator care adjustment as
outlined in the administrative rules of the Department of
Healthcare and Family Services;
(2) at a minimum a $5 per day add-on for each resident
residing in a dedicated Alzheimer's unit with an
Alzheimer's or a non-Alzheimer's dementia diagnosis as
scored on the MDS 3.0;
(3) at a minimum a $2.50 per day add-on for each
resident falling in the bottom 4 RUG-IV groupers with an
Alzheimer's or a non-Alzheimer's dementia diagnosis not
residing in a dedicated Alzheimer's unit as scored on the

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MDS 3.0; and
(4) at a minimum a $3.00 per day add-on for each
resident with a diagnosis of a serious mental illness. If
for any quarter the amount needed for the serious mental
illness add-on is less than $2,000,000, the difference
shall be added to the base rate adjustment as provided in
paragraph (3-1) of subsection (d-1).
For the purpose of the add-on calculations, a dedicated
Alzheimer's unit must meet the criteria set forth in Subpart U
of Title 77, Part 300 of the Illinois Administrative Code.
"Serious mental illness" means a primary or secondary SMI
diagnosis in one of MDS 3.0 items S1200 A through I.
"Alzheimer's" and "non-Alzheimer's dementia" means a diagnosis
in MDS 3.0 item I4200 or I4800.
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,

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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

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(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) Notwithstanding any other provision of this Code, an
amount equal to $16,000,000 shall be set aside for the
establishment of a quality incentive initiative effective
January 1, 2015. In any quarter in which quality incentive
awards do not equal $16,000,000, the difference shall be added
to the base rate adjustment as provided in paragraph (3-1) of
subsection (d-1).
(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:

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(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.".