Bill Text: IL SB1667 | 2011-2012 | 97th General Assembly | Amended

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Bill Title: Amends the Illinois Public Aid Code. Changes the date on when the Department of Healthcare and Family Services shall implement an evidence-based payment methodology for the reimbursement of nursing facility services and requires the revised methodology to incorporate patient acuity, patient health outcomes, and measures of quality and quality improvement for the determination of payment. Removes a provision requiring the Department to develop enhanced payments to offset the additional costs incurred by a facility serving exceptional need residents. Provides that licensed bed days shall be computed separately for each nursing home operated or maintained by a nursing home provider. Changes the assessment rate for long-term care providers to $2.04 times the number of licensed bed days (rather than $6.07 times the number of occupied bed days) due and payable each month. Repeals provisions concerning licensed nursing bed day fees. Effective upon becoming law or on the effective date of Senate Bill 3088 of the 96th General Assembly, whichever is later.

Spectrum: Partisan Bill (Democrat 5-0)

Status: (Failed) 2013-01-08 - Session Sine Die [SB1667 Detail]

Download: Illinois-2011-SB1667-Amended.html

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Sen. Heather A. Steans

Filed: 3/10/2011

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AMENDMENT TO SENATE BILL 1667
AMENDMENT NO. ______. Amend Senate Bill 1667 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Public Aid Code is amended by
changing Section 5-5.4 as follows:
(305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
Sec. 5-5.4. Standards of Payment - Department of Healthcare
and Family Services. The The Department of Healthcare and
Family Services shall develop standards of payment of nursing
facility and ICF/DD services in facilities providing such
services under this Article which:
(1) Provide for the determination of a facility's payment
for nursing facility or ICF/DD services on a prospective basis.
The amount of the payment rate for all nursing facilities
certified by the Department of Public Health under the MR/DD
Community Care Act or the Nursing Home Care Act as Intermediate

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Care for the Developmentally Disabled facilities, Long Term
Care for Under Age 22 facilities, Skilled Nursing facilities,
or Intermediate Care facilities under the medical assistance
program shall be prospectively established annually on the
basis of historical, financial, and statistical data
reflecting actual costs from prior years, which shall be
applied to the current rate year and updated for inflation,
except that the capital cost element for newly constructed
facilities shall be based upon projected budgets. The annually
established payment rate shall take effect on July 1 in 1984
and subsequent years. No rate increase and no update for
inflation shall be provided on or after July 1, 1994 and before
July 1, 2012, unless specifically provided for in this Section.
The changes made by Public Act 93-841 extending the duration of
the prohibition against a rate increase or update for inflation
are effective retroactive to July 1, 2004.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on July 1, 1998
shall include an increase of 3%. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Skilled Nursing facilities or Intermediate Care facilities,
the rates taking effect on July 1, 1998 shall include an
increase of 3% plus $1.10 per resident-day, as defined by the
Department. For facilities licensed by the Department of Public

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Health under the Nursing Home Care Act as Intermediate Care
Facilities for the Developmentally Disabled or Long Term Care
for Under Age 22 facilities, the rates taking effect on January
1, 2006 shall include an increase of 3%. For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Intermediate Care Facilities for the
Developmentally Disabled or Long Term Care for Under Age 22
facilities, the rates taking effect on January 1, 2009 shall
include an increase sufficient to provide a $0.50 per hour wage
increase for non-executive staff.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on July 1, 1999
shall include an increase of 1.6% plus $3.00 per resident-day,
as defined by the Department. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Skilled Nursing facilities or Intermediate Care facilities,
the rates taking effect on July 1, 1999 shall include an
increase of 1.6% and, for services provided on or after October
1, 1999, shall be increased by $4.00 per resident-day, as
defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on July 1, 2000

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shall include an increase of 2.5% per resident-day, as defined
by the Department. For facilities licensed by the Department of
Public Health under the Nursing Home Care Act as Skilled
Nursing facilities or Intermediate Care facilities, the rates
taking effect on July 1, 2000 shall include an increase of 2.5%
per resident-day, as defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities
or intermediate care facilities, a new payment methodology must
be implemented for the nursing component of the rate effective
July 1, 2003. The Department of Public Aid (now Healthcare and
Family Services) shall develop the new payment methodology
using the Minimum Data Set (MDS) as the instrument to collect
information concerning nursing home resident condition
necessary to compute the rate. The Department shall develop the
new payment methodology to meet the unique needs of Illinois
nursing home residents while remaining subject to the
appropriations provided by the General Assembly. A transition
period from the payment methodology in effect on June 30, 2003
to the payment methodology in effect on July 1, 2003 shall be
provided for a period not exceeding 3 years and 184 days after
implementation of the new payment methodology as follows:
(A) For a facility that would receive a lower nursing
component rate per patient day under the new system than
the facility received effective on the date immediately
preceding the date that the Department implements the new

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payment methodology, the nursing component rate per
patient day for the facility shall be held at the level in
effect on the date immediately preceding the date that the
Department implements the new payment methodology until a
higher nursing component rate of reimbursement is achieved
by that facility.
(B) For a facility that would receive a higher nursing
component rate per patient day under the payment
methodology in effect on July 1, 2003 than the facility
received effective on the date immediately preceding the
date that the Department implements the new payment
methodology, the nursing component rate per patient day for
the facility shall be adjusted.
(C) Notwithstanding paragraphs (A) and (B), the
nursing component rate per patient day for the facility
shall be adjusted subject to appropriations provided by the
General Assembly.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on March 1, 2001
shall include a statewide increase of 7.85%, as defined by the
Department.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or

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intermediate care facilities, except facilities participating
in the Department's demonstration program pursuant to the
provisions of Title 77, Part 300, Subpart T of the Illinois
Administrative Code, the numerator of the ratio used by the
Department of Healthcare and Family Services to compute the
rate payable under this Section using the Minimum Data Set
(MDS) methodology shall incorporate the following annual
amounts as the additional funds appropriated to the Department
specifically to pay for rates based on the MDS nursing
component methodology in excess of the funding in effect on
December 31, 2006:
(i) For rates taking effect January 1, 2007,
$60,000,000.
(ii) For rates taking effect January 1, 2008,
$110,000,000.
(iii) For rates taking effect January 1, 2009,
$194,000,000.
(iv) For rates taking effect April 1, 2011, or the
first day of the month that begins at least 45 days after
the effective date of this amendatory Act of the 96th
General Assembly, $416,500,000 or an amount as may be
necessary to complete the transition to the MDS methodology
for the nursing component of the rate.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or

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intermediate care facilities, the support component of the
rates taking effect on January 1, 2008 shall be computed using
the most recent cost reports on file with the Department of
Healthcare and Family Services no later than April 1, 2005,
updated for inflation to January 1, 2006.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on April 1, 2002
shall include a statewide increase of 2.0%, as defined by the
Department. This increase terminates on July 1, 2002; beginning
July 1, 2002 these rates are reduced to the level of the rates
in effect on March 31, 2002, as defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities
or intermediate care facilities, the rates taking effect on
July 1, 2001 shall be computed using the most recent cost
reports on file with the Department of Public Aid no later than
April 1, 2000, updated for inflation to January 1, 2001. For
rates effective July 1, 2001 only, rates shall be the greater
of the rate computed for July 1, 2001 or the rate effective on
June 30, 2001.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the Illinois Department shall

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determine by rule the rates taking effect on July 1, 2002,
which shall be 5.9% less than the rates in effect on June 30,
2002.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, if the payment methodologies
required under Section 5A-12 and the waiver granted under 42
CFR 433.68 are approved by the United States Centers for
Medicare and Medicaid Services, the rates taking effect on July
1, 2004 shall be 3.0% greater than the rates in effect on June
30, 2004. These rates shall take effect only upon approval and
implementation of the payment methodologies required under
Section 5A-12.
Notwithstanding any other provisions of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the rates taking effect on
January 1, 2005 shall be 3% more than the rates in effect on
December 31, 2004.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, effective January 1, 2009, the
per diem support component of the rates effective on January 1,
2008, computed using the most recent cost reports on file with

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the Department of Healthcare and Family Services no later than
April 1, 2005, updated for inflation to January 1, 2006, shall
be increased to the amount that would have been derived using
standard Department of Healthcare and Family Services methods,
procedures, and inflators.
Notwithstanding any other provisions of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as intermediate care facilities that
are federally defined as Institutions for Mental Disease, a
socio-development component rate equal to 6.6% of the
facility's nursing component rate as of January 1, 2006 shall
be established and paid effective July 1, 2006. The
socio-development component of the rate shall be increased by a
factor of 2.53 on the first day of the month that begins at
least 45 days after January 11, 2008 (the effective date of
Public Act 95-707). As of August 1, 2008, the socio-development
component rate shall be equal to 6.6% of the facility's nursing
component rate as of January 1, 2006, multiplied by a factor of
3.53. For services provided on or after April 1, 2011, or the
first day of the month that begins at least 45 days after the
effective date of this amendatory Act of the 96th General
Assembly, whichever is later, the Illinois Department may by
rule adjust these socio-development component rates, and may
use different adjustment methodologies for those facilities
participating, and those not participating, in the Illinois
Department's demonstration program pursuant to the provisions

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of Title 77, Part 300, Subpart T of the Illinois Administrative
Code, but in no case may such rates be diminished below those
in effect on August 1, 2008.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or as long-term care
facilities for residents under 22 years of age, the rates
taking effect on July 1, 2003 shall include a statewide
increase of 4%, as defined by the Department.
For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on the first day of
the month that begins at least 45 days after the effective date
of this amendatory Act of the 95th General Assembly shall
include a statewide increase of 2.5%, as defined by the
Department.
Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, effective January 1, 2005,
facility rates shall be increased by the difference between (i)
a facility's per diem property, liability, and malpractice
insurance costs as reported in the cost report filed with the
Department of Public Aid and used to establish rates effective
July 1, 2001 and (ii) those same costs as reported in the

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facility's 2002 cost report. These costs shall be passed
through to the facility without caps or limitations, except for
adjustments required under normal auditing procedures.
Rates established effective each July 1 shall govern
payment for services rendered throughout that fiscal year,
except that rates established on July 1, 1996 shall be
increased by 6.8% for services provided on or after January 1,
1997. Such rates will be based upon the rates calculated for
the year beginning July 1, 1990, and for subsequent years
thereafter until June 30, 2001 shall be based on the facility
cost reports for the facility fiscal year ending at any point
in time during the previous calendar year, updated to the
midpoint of the rate year. The cost report shall be on file
with the Department no later than April 1 of the current rate
year. Should the cost report not be on file by April 1, the
Department shall base the rate on the latest cost report filed
by each skilled care facility and intermediate care facility,
updated to the midpoint of the current rate year. In
determining rates for services rendered on and after July 1,
1985, fixed time shall not be computed at less than zero. The
Department shall not make any alterations of regulations which
would reduce any component of the Medicaid rate to a level
below what that component would have been utilizing in the rate
effective on July 1, 1984.
(2) Shall take into account the actual costs incurred by
facilities in providing services for recipients of skilled

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nursing and intermediate care services under the medical
assistance program.
(3) Shall take into account the medical and psycho-social
characteristics and needs of the patients.
(4) Shall take into account the actual costs incurred by
facilities in meeting licensing and certification standards
imposed and prescribed by the State of Illinois, any of its
political subdivisions or municipalities and by the U.S.
Department of Health and Human Services pursuant to Title XIX
of the Social Security Act.
The Department of Healthcare and Family Services shall
develop precise standards for payments to reimburse nursing
facilities for any utilization of appropriate rehabilitative
personnel for the provision of rehabilitative services which is
authorized by federal regulations, including reimbursement for
services provided by qualified therapists or qualified
assistants, and which is in accordance with accepted
professional practices. Reimbursement also may be made for
utilization of other supportive personnel under appropriate
supervision.
The Department shall develop enhanced payments to offset
the additional costs incurred by a facility serving exceptional
need residents and shall allocate at least $8,000,000 of the
funds collected from the assessment established by Section 5B-2
of this Code for such payments. For the purpose of this
Section, "exceptional needs" means, but need not be limited to,

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ventilator care, tracheotomy care, bariatric care, complex
wound care, and traumatic brain injury care.
(5) Beginning July 1, 2012 the methodologies for
reimbursement of nursing facility services as provided under
this Section 5-5.4 shall no longer be applicable for bills
payable for State fiscal years 2012 and thereafter.
(Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707,
eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09;
96-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10;
96-1530, eff. 2-16-11.)".