Bill Text: IL SB3006 | 2009-2010 | 96th General Assembly | Introduced
Bill Title: Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning standards of payment of skilled nursing and intermediate care services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-02-04 - Referred to Assignments [SB3006 Detail]
Download: Illinois-2009-SB3006-Introduced.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 5-5.4 as follows:
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| 6 | (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
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| 7 | (Text of Section before amendment by P.A. 96-339) | |||||||||||||||||||
| 8 | Sec. 5-5.4. Standards of Payment - Department of Healthcare | |||||||||||||||||||
| 9 | and Family Services.
The The Department of Healthcare and | |||||||||||||||||||
| 10 | Family Services shall develop standards of payment of skilled
| |||||||||||||||||||
| 11 | nursing and intermediate care services in facilities providing | |||||||||||||||||||
| 12 | such services
under this Article which:
| |||||||||||||||||||
| 13 | (1) Provide for the determination of a facility's payment
| |||||||||||||||||||
| 14 | for skilled nursing and intermediate care services on a | |||||||||||||||||||
| 15 | prospective basis.
The amount of the payment rate for all | |||||||||||||||||||
| 16 | nursing facilities certified by the
Department of Public Health | |||||||||||||||||||
| 17 | under the Nursing Home Care Act as Intermediate
Care for the | |||||||||||||||||||
| 18 | Developmentally Disabled facilities, Long Term Care for Under | |||||||||||||||||||
| 19 | Age
22 facilities, Skilled Nursing facilities, or Intermediate | |||||||||||||||||||
| 20 | Care facilities
under the
medical assistance program shall be | |||||||||||||||||||
| 21 | prospectively established annually on the
basis of historical, | |||||||||||||||||||
| 22 | financial, and statistical data reflecting actual costs
from | |||||||||||||||||||
| 23 | prior years, which shall be applied to the current rate year | |||||||||||||||||||
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| |||||||
| 1 | and updated
for inflation, except that the capital cost element | ||||||
| 2 | for newly constructed
facilities shall be based upon projected | ||||||
| 3 | budgets. The annually established
payment rate shall take | ||||||
| 4 | effect on July 1 in 1984 and subsequent years. No rate
increase | ||||||
| 5 | and no
update for inflation shall be provided on or after July | ||||||
| 6 | 1, 1994 and before
July 1, 2010, unless specifically provided | ||||||
| 7 | for in this
Section.
The changes made by Public Act 93-841
| ||||||
| 8 | extending the duration of the prohibition against a rate | ||||||
| 9 | increase or update for inflation are effective retroactive to | ||||||
| 10 | July 1, 2004.
| ||||||
| 11 | For facilities licensed by the Department of Public Health | ||||||
| 12 | under the Nursing
Home Care Act as Intermediate Care for the | ||||||
| 13 | Developmentally Disabled facilities
or Long Term Care for Under | ||||||
| 14 | Age 22 facilities, the rates taking effect on July
1, 1998 | ||||||
| 15 | shall include an increase of 3%. For facilities licensed by the
| ||||||
| 16 | Department of Public Health under the Nursing Home Care Act as | ||||||
| 17 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
| 18 | the rates taking effect on July 1,
1998 shall include an | ||||||
| 19 | increase of 3% plus $1.10 per resident-day, as defined by
the | ||||||
| 20 | Department. For facilities licensed by the Department of Public | ||||||
| 21 | Health under the Nursing Home Care Act as Intermediate Care | ||||||
| 22 | Facilities for the Developmentally Disabled or Long Term Care | ||||||
| 23 | for Under Age 22 facilities, the rates taking effect on January | ||||||
| 24 | 1, 2006 shall include an increase of 3%.
For facilities | ||||||
| 25 | licensed by the Department of Public Health under the Nursing | ||||||
| 26 | Home Care Act as Intermediate Care Facilities for the | ||||||
| |||||||
| |||||||
| 1 | Developmentally Disabled or Long Term Care for Under Age 22 | ||||||
| 2 | facilities, the rates taking effect on January 1, 2009 shall | ||||||
| 3 | include an increase sufficient to provide a $0.50 per hour wage | ||||||
| 4 | increase for non-executive staff.
| ||||||
| 5 | For facilities licensed by the Department of Public Health | ||||||
| 6 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 7 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 8 | Age 22 facilities, the rates taking
effect on July 1, 1999 | ||||||
| 9 | shall include an increase of 1.6% plus $3.00 per
resident-day, | ||||||
| 10 | as defined by the Department. For facilities licensed by the
| ||||||
| 11 | Department of Public Health under the Nursing Home Care Act as | ||||||
| 12 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
| 13 | the rates taking effect on July 1,
1999 shall include an | ||||||
| 14 | increase of 1.6% and, for services provided on or after
October | ||||||
| 15 | 1, 1999, shall be increased by $4.00 per resident-day, as | ||||||
| 16 | defined by
the Department.
| ||||||
| 17 | For facilities licensed by the Department of Public Health | ||||||
| 18 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 19 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 20 | Age 22 facilities, the rates taking
effect on July 1, 2000 | ||||||
| 21 | shall include an increase of 2.5% per resident-day,
as defined | ||||||
| 22 | by the Department. For facilities licensed by the Department of
| ||||||
| 23 | Public Health under the Nursing Home Care Act as Skilled | ||||||
| 24 | Nursing facilities or
Intermediate Care facilities, the rates | ||||||
| 25 | taking effect on July 1, 2000 shall
include an increase of 2.5% | ||||||
| 26 | per resident-day, as defined by the Department.
| ||||||
| |||||||
| |||||||
| 1 | For facilities licensed by the Department of Public Health | ||||||
| 2 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
| 3 | or intermediate care
facilities, a new payment methodology must | ||||||
| 4 | be implemented for the nursing
component of the rate effective | ||||||
| 5 | July 1, 2003. The Department of Public Aid
(now Healthcare and | ||||||
| 6 | Family Services) shall develop the new payment methodology | ||||||
| 7 | using the Minimum Data Set
(MDS) as the instrument to collect | ||||||
| 8 | information concerning nursing home
resident condition | ||||||
| 9 | necessary to compute the rate. The Department
shall develop the | ||||||
| 10 | new payment methodology to meet the unique needs of
Illinois | ||||||
| 11 | nursing home residents while remaining subject to the | ||||||
| 12 | appropriations
provided by the General Assembly.
A transition | ||||||
| 13 | period from the payment methodology in effect on June 30, 2003
| ||||||
| 14 | to the payment methodology in effect on July 1, 2003 shall be | ||||||
| 15 | provided for a
period not exceeding 3 years and 184 days after | ||||||
| 16 | implementation of the new payment
methodology as follows:
| ||||||
| 17 | (A) For a facility that would receive a lower
nursing | ||||||
| 18 | component rate per patient day under the new system than | ||||||
| 19 | the facility
received
effective on the date immediately | ||||||
| 20 | preceding the date that the Department
implements the new | ||||||
| 21 | payment methodology, the nursing component rate per | ||||||
| 22 | patient
day for the facility
shall be held at
the level in | ||||||
| 23 | effect on the date immediately preceding the date that the
| ||||||
| 24 | Department implements the new payment methodology until a | ||||||
| 25 | higher nursing
component rate of
reimbursement is achieved | ||||||
| 26 | by that
facility.
| ||||||
| |||||||
| |||||||
| 1 | (B) For a facility that would receive a higher nursing | ||||||
| 2 | component rate per
patient day under the payment | ||||||
| 3 | methodology in effect on July 1, 2003 than the
facility | ||||||
| 4 | received effective on the date immediately preceding the | ||||||
| 5 | date that the
Department implements the new payment | ||||||
| 6 | methodology, the nursing component rate
per patient day for | ||||||
| 7 | the facility shall be adjusted.
| ||||||
| 8 | (C) Notwithstanding paragraphs (A) and (B), the | ||||||
| 9 | nursing component rate per
patient day for the facility | ||||||
| 10 | shall be adjusted subject to appropriations
provided by the | ||||||
| 11 | General Assembly.
| ||||||
| 12 | For facilities licensed by the Department of Public Health | ||||||
| 13 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 14 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 15 | Age 22 facilities, the rates taking
effect on March 1, 2001 | ||||||
| 16 | shall include a statewide increase of 7.85%, as
defined by the | ||||||
| 17 | Department.
| ||||||
| 18 | Notwithstanding any other provision of this Section, for | ||||||
| 19 | facilities licensed by the Department of Public Health under | ||||||
| 20 | the
Nursing Home Care Act as skilled nursing facilities or | ||||||
| 21 | intermediate care
facilities, the numerator of the ratio used | ||||||
| 22 | by the Department of Healthcare and Family Services to compute | ||||||
| 23 | the rate payable under this Section using the Minimum Data Set | ||||||
| 24 | (MDS) methodology shall incorporate the following annual | ||||||
| 25 | amounts as the additional funds appropriated to the Department | ||||||
| 26 | specifically to pay for rates based on the MDS nursing | ||||||
| |||||||
| |||||||
| 1 | component methodology in excess of the funding in effect on | ||||||
| 2 | December 31, 2006: | ||||||
| 3 | (i) For rates taking effect January 1, 2007, | ||||||
| 4 | $60,000,000. | ||||||
| 5 | (ii) For rates taking effect January 1, 2008, | ||||||
| 6 | $110,000,000. | ||||||
| 7 | (iii) For rates taking effect January 1, 2009, | ||||||
| 8 | $194,000,000. | ||||||
| 9 | Notwithstanding any other provision of this Section, for | ||||||
| 10 | facilities licensed by the Department of Public Health under | ||||||
| 11 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
| 12 | intermediate care facilities, the support component of the | ||||||
| 13 | rates taking effect on January 1, 2008 shall be computed using | ||||||
| 14 | the most recent cost reports on file with the Department of | ||||||
| 15 | Healthcare and Family Services no later than April 1, 2005, | ||||||
| 16 | updated for inflation to January 1, 2006. | ||||||
| 17 | For facilities licensed by the Department of Public Health | ||||||
| 18 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 19 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 20 | Age 22 facilities, the rates taking
effect on April 1, 2002 | ||||||
| 21 | shall include a statewide increase of 2.0%, as
defined by the | ||||||
| 22 | Department.
This increase terminates on July 1, 2002;
beginning | ||||||
| 23 | July 1, 2002 these rates are reduced to the level of the rates
| ||||||
| 24 | in effect on March 31, 2002, as defined by the Department.
| ||||||
| 25 | For facilities licensed by the Department of Public Health | ||||||
| 26 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
| |||||||
| |||||||
| 1 | or intermediate care
facilities, the rates taking effect on | ||||||
| 2 | July 1, 2001 shall be computed using the most recent cost | ||||||
| 3 | reports
on file with the Department of Public Aid no later than | ||||||
| 4 | April 1, 2000,
updated for inflation to January 1, 2001. For | ||||||
| 5 | rates effective July 1, 2001
only, rates shall be the greater | ||||||
| 6 | of the rate computed for July 1, 2001
or the rate effective on | ||||||
| 7 | June 30, 2001.
| ||||||
| 8 | Notwithstanding any other provision of this Section, for | ||||||
| 9 | facilities
licensed by the Department of Public Health under | ||||||
| 10 | the Nursing Home Care Act
as skilled nursing facilities or | ||||||
| 11 | intermediate care facilities, the Illinois
Department shall | ||||||
| 12 | determine by rule the rates taking effect on July 1, 2002,
| ||||||
| 13 | which shall be 5.9% less than the rates in effect on June 30, | ||||||
| 14 | 2002.
| ||||||
| 15 | Notwithstanding any other provision of this Section, for | ||||||
| 16 | facilities
licensed by the Department of Public Health under | ||||||
| 17 | the Nursing Home Care Act as
skilled nursing
facilities or | ||||||
| 18 | intermediate care facilities, if the payment methodologies | ||||||
| 19 | required under Section 5A-12 and the waiver granted under 42 | ||||||
| 20 | CFR 433.68 are approved by the United States Centers for | ||||||
| 21 | Medicare and Medicaid Services, the rates taking effect on July | ||||||
| 22 | 1, 2004 shall be 3.0% greater than the rates in effect on June | ||||||
| 23 | 30, 2004. These rates shall take
effect only upon approval and
| ||||||
| 24 | implementation of the payment methodologies required under | ||||||
| 25 | Section 5A-12.
| ||||||
| 26 | Notwithstanding any other provisions of this Section, for | ||||||
| |||||||
| |||||||
| 1 | facilities licensed by the Department of Public Health under | ||||||
| 2 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
| 3 | intermediate care facilities, the rates taking effect on | ||||||
| 4 | January 1, 2005 shall be 3% more than the rates in effect on | ||||||
| 5 | December 31, 2004.
| ||||||
| 6 | Notwithstanding any other provision of this Section, for | ||||||
| 7 | facilities licensed by the Department of Public Health under | ||||||
| 8 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
| 9 | intermediate care facilities, effective January 1, 2009, the | ||||||
| 10 | per diem support component of the rates effective on January 1, | ||||||
| 11 | 2008, computed using the most recent cost reports on file with | ||||||
| 12 | the Department of Healthcare and Family Services no later than | ||||||
| 13 | April 1, 2005, updated for inflation to January 1, 2006, shall | ||||||
| 14 | be increased to the amount that would have been derived using | ||||||
| 15 | standard Department of Healthcare and Family Services methods, | ||||||
| 16 | procedures, and inflators. | ||||||
| 17 | Notwithstanding any other provisions of this Section, for | ||||||
| 18 | facilities licensed by the Department of Public Health under | ||||||
| 19 | the Nursing Home Care Act as intermediate care facilities that | ||||||
| 20 | are federally defined as Institutions for Mental Disease, a | ||||||
| 21 | socio-development component rate equal to 6.6% of the | ||||||
| 22 | facility's nursing component rate as of January 1, 2006 shall | ||||||
| 23 | be established and paid effective July 1, 2006. The | ||||||
| 24 | socio-development component of the rate shall be increased by a | ||||||
| 25 | factor of 2.53 on the first day of the month that begins at | ||||||
| 26 | least 45 days after January 11, 2008 (the effective date of | ||||||
| |||||||
| |||||||
| 1 | Public Act 95-707). As of August 1, 2008, the socio-development | ||||||
| 2 | component rate shall be equal to 6.6% of the facility's nursing | ||||||
| 3 | component rate as of January 1, 2006, multiplied by a factor of | ||||||
| 4 | 3.53. The Illinois Department may by rule adjust these | ||||||
| 5 | socio-development component rates, but in no case may such | ||||||
| 6 | rates be diminished.
| ||||||
| 7 | For facilities
licensed
by the
Department of Public Health | ||||||
| 8 | under the Nursing Home Care Act as Intermediate
Care for
the | ||||||
| 9 | Developmentally Disabled facilities or as long-term care | ||||||
| 10 | facilities for
residents under 22 years of age, the rates | ||||||
| 11 | taking effect on July 1,
2003 shall
include a statewide | ||||||
| 12 | increase of 4%, as defined by the Department.
| ||||||
| 13 | For facilities licensed by the Department of Public Health | ||||||
| 14 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 15 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 16 | Age 22 facilities, the rates taking
effect on the first day of | ||||||
| 17 | the month that begins at least 45 days after the effective date | ||||||
| 18 | of this amendatory Act of the 95th General Assembly shall | ||||||
| 19 | include a statewide increase of 2.5%, as
defined by the | ||||||
| 20 | Department. | ||||||
| 21 | Notwithstanding any other provision of this Section, for | ||||||
| 22 | facilities licensed by the Department of Public Health under | ||||||
| 23 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
| 24 | intermediate care facilities, effective January 1, 2005, | ||||||
| 25 | facility rates shall be increased by the difference between (i) | ||||||
| 26 | a facility's per diem property, liability, and malpractice | ||||||
| |||||||
| |||||||
| 1 | insurance costs as reported in the cost report filed with the | ||||||
| 2 | Department of Public Aid and used to establish rates effective | ||||||
| 3 | July 1, 2001 and (ii) those same costs as reported in the | ||||||
| 4 | facility's 2002 cost report. These costs shall be passed | ||||||
| 5 | through to the facility without caps or limitations, except for | ||||||
| 6 | adjustments required under normal auditing procedures.
| ||||||
| 7 | Rates established effective each July 1 shall govern | ||||||
| 8 | payment
for services rendered throughout that fiscal year, | ||||||
| 9 | except that rates
established on July 1, 1996 shall be | ||||||
| 10 | increased by 6.8% for services
provided on or after January 1, | ||||||
| 11 | 1997. Such rates will be based
upon the rates calculated for | ||||||
| 12 | the year beginning July 1, 1990, and for
subsequent years | ||||||
| 13 | thereafter until June 30, 2001 shall be based on the
facility | ||||||
| 14 | cost reports
for the facility fiscal year ending at any point | ||||||
| 15 | in time during the previous
calendar year, updated to the | ||||||
| 16 | midpoint of the rate year. The cost report
shall be on file | ||||||
| 17 | with the Department no later than April 1 of the current
rate | ||||||
| 18 | year. Should the cost report not be on file by April 1, the | ||||||
| 19 | Department
shall base the rate on the latest cost report filed | ||||||
| 20 | by each skilled care
facility and intermediate care facility, | ||||||
| 21 | updated to the midpoint of the
current rate year. In | ||||||
| 22 | determining rates for services rendered on and after
July 1, | ||||||
| 23 | 1985, fixed time shall not be computed at less than zero. The
| ||||||
| 24 | Department shall not make any alterations of regulations which | ||||||
| 25 | would reduce
any component of the Medicaid rate to a level | ||||||
| 26 | below what that component would
have been utilizing in the rate | ||||||
| |||||||
| |||||||
| 1 | effective on July 1, 1984.
| ||||||
| 2 | (2) Shall take into account the actual costs incurred by | ||||||
| 3 | facilities
in providing services for recipients of skilled | ||||||
| 4 | nursing and intermediate
care services under the medical | ||||||
| 5 | assistance program.
| ||||||
| 6 | (3) Shall take into account the medical and psycho-social
| ||||||
| 7 | characteristics and needs of the patients.
| ||||||
| 8 | (4) Shall take into account the actual costs incurred by | ||||||
| 9 | facilities in
meeting licensing and certification standards | ||||||
| 10 | imposed and prescribed by the
State of Illinois, any of its | ||||||
| 11 | political subdivisions or municipalities and by
the U.S. | ||||||
| 12 | Department of Health and Human Services pursuant to Title XIX | ||||||
| 13 | of the
Social Security Act.
| ||||||
| 14 | The Department of Healthcare and Family Services
shall | ||||||
| 15 | develop precise standards for
payments to reimburse nursing | ||||||
| 16 | facilities for any utilization of
appropriate rehabilitative | ||||||
| 17 | personnel for the provision of rehabilitative
services which is | ||||||
| 18 | authorized by federal regulations, including
reimbursement for | ||||||
| 19 | services provided by qualified therapists or qualified
| ||||||
| 20 | assistants, and which is in accordance with accepted | ||||||
| 21 | professional
practices. Reimbursement also may be made for | ||||||
| 22 | utilization of other
supportive personnel under appropriate | ||||||
| 23 | supervision.
| ||||||
| 24 | (Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707, | ||||||
| 25 | eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09.)
| ||||||
| |||||||
| |||||||
| 1 | (Text of Section after amendment by P.A. 96-339) | ||||||
| 2 | Sec. 5-5.4. Standards of Payment - Department of Healthcare | ||||||
| 3 | and Family Services.
The The Department of Healthcare and | ||||||
| 4 | Family Services shall develop standards of payment of skilled
| ||||||
| 5 | nursing and intermediate care services in facilities providing | ||||||
| 6 | such services
under this Article which:
| ||||||
| 7 | (1) Provide for the determination of a facility's payment
| ||||||
| 8 | for skilled nursing and intermediate care services on a | ||||||
| 9 | prospective basis.
The amount of the payment rate for all | ||||||
| 10 | nursing facilities certified by the
Department of Public Health | ||||||
| 11 | under the MR/DD Community Care Act or the Nursing Home Care Act | ||||||
| 12 | as Intermediate
Care for the Developmentally Disabled | ||||||
| 13 | facilities, Long Term Care for Under Age
22 facilities, Skilled | ||||||
| 14 | Nursing facilities, or Intermediate Care facilities
under the
| ||||||
| 15 | medical assistance program shall be prospectively established | ||||||
| 16 | annually on the
basis of historical, financial, and statistical | ||||||
| 17 | data reflecting actual costs
from prior years, which shall be | ||||||
| 18 | applied to the current rate year and updated
for inflation, | ||||||
| 19 | except that the capital cost element for newly constructed
| ||||||
| 20 | facilities shall be based upon projected budgets. The annually | ||||||
| 21 | established
payment rate shall take effect on July 1 in 1984 | ||||||
| 22 | and subsequent years. No rate
increase and no
update for | ||||||
| 23 | inflation shall be provided on or after July 1, 1994 and before
| ||||||
| 24 | July 1, 2010, unless specifically provided for in this
Section.
| ||||||
| 25 | The changes made by Public Act 93-841
extending the duration of | ||||||
| 26 | the prohibition against a rate increase or update for inflation | ||||||
| |||||||
| |||||||
| 1 | are effective retroactive to July 1, 2004.
| ||||||
| 2 | For facilities licensed by the Department of Public Health | ||||||
| 3 | under the Nursing
Home Care Act as Intermediate Care for the | ||||||
| 4 | Developmentally Disabled facilities
or Long Term Care for Under | ||||||
| 5 | Age 22 facilities, the rates taking effect on July
1, 1998 | ||||||
| 6 | shall include an increase of 3%. For facilities licensed by the
| ||||||
| 7 | Department of Public Health under the Nursing Home Care Act as | ||||||
| 8 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
| 9 | the rates taking effect on July 1,
1998 shall include an | ||||||
| 10 | increase of 3% plus $1.10 per resident-day, as defined by
the | ||||||
| 11 | Department. For facilities licensed by the Department of Public | ||||||
| 12 | Health under the Nursing Home Care Act as Intermediate Care | ||||||
| 13 | Facilities for the Developmentally Disabled or Long Term Care | ||||||
| 14 | for Under Age 22 facilities, the rates taking effect on January | ||||||
| 15 | 1, 2006 shall include an increase of 3%.
For facilities | ||||||
| 16 | licensed by the Department of Public Health under the Nursing | ||||||
| 17 | Home Care Act as Intermediate Care Facilities for the | ||||||
| 18 | Developmentally Disabled or Long Term Care for Under Age 22 | ||||||
| 19 | facilities, the rates taking effect on January 1, 2009 shall | ||||||
| 20 | include an increase sufficient to provide a $0.50 per hour wage | ||||||
| 21 | increase for non-executive staff.
| ||||||
| 22 | For facilities licensed by the Department of Public Health | ||||||
| 23 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 24 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 25 | Age 22 facilities, the rates taking
effect on July 1, 1999 | ||||||
| 26 | shall include an increase of 1.6% plus $3.00 per
resident-day, | ||||||
| |||||||
| |||||||
| 1 | as defined by the Department. For facilities licensed by the
| ||||||
| 2 | Department of Public Health under the Nursing Home Care Act as | ||||||
| 3 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
| 4 | the rates taking effect on July 1,
1999 shall include an | ||||||
| 5 | increase of 1.6% and, for services provided on or after
October | ||||||
| 6 | 1, 1999, shall be increased by $4.00 per resident-day, as | ||||||
| 7 | defined by
the Department.
| ||||||
| 8 | For facilities licensed by the Department of Public Health | ||||||
| 9 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 10 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 11 | Age 22 facilities, the rates taking
effect on July 1, 2000 | ||||||
| 12 | shall include an increase of 2.5% per resident-day,
as defined | ||||||
| 13 | by the Department. For facilities licensed by the Department of
| ||||||
| 14 | Public Health under the Nursing Home Care Act as Skilled | ||||||
| 15 | Nursing facilities or
Intermediate Care facilities, the rates | ||||||
| 16 | taking effect on July 1, 2000 shall
include an increase of 2.5% | ||||||
| 17 | per resident-day, as defined by the Department.
| ||||||
| 18 | For facilities licensed by the Department of Public Health | ||||||
| 19 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
| 20 | or intermediate care
facilities, a new payment methodology must | ||||||
| 21 | be implemented for the nursing
component of the rate effective | ||||||
| 22 | July 1, 2003. The Department of Public Aid
(now Healthcare and | ||||||
| 23 | Family Services) shall develop the new payment methodology | ||||||
| 24 | using the Minimum Data Set
(MDS) as the instrument to collect | ||||||
| 25 | information concerning nursing home
resident condition | ||||||
| 26 | necessary to compute the rate. The Department
shall develop the | ||||||
| |||||||
| |||||||
| 1 | new payment methodology to meet the unique needs of
Illinois | ||||||
| 2 | nursing home residents while remaining subject to the | ||||||
| 3 | appropriations
provided by the General Assembly.
A transition | ||||||
| 4 | period from the payment methodology in effect on June 30, 2003
| ||||||
| 5 | to the payment methodology in effect on July 1, 2003 shall be | ||||||
| 6 | provided for a
period not exceeding 3 years and 184 days after | ||||||
| 7 | implementation of the new payment
methodology as follows:
| ||||||
| 8 | (A) For a facility that would receive a lower
nursing | ||||||
| 9 | component rate per patient day under the new system than | ||||||
| 10 | the facility
received
effective on the date immediately | ||||||
| 11 | preceding the date that the Department
implements the new | ||||||
| 12 | payment methodology, the nursing component rate per | ||||||
| 13 | patient
day for the facility
shall be held at
the level in | ||||||
| 14 | effect on the date immediately preceding the date that the
| ||||||
| 15 | Department implements the new payment methodology until a | ||||||
| 16 | higher nursing
component rate of
reimbursement is achieved | ||||||
| 17 | by that
facility.
| ||||||
| 18 | (B) For a facility that would receive a higher nursing | ||||||
| 19 | component rate per
patient day under the payment | ||||||
| 20 | methodology in effect on July 1, 2003 than the
facility | ||||||
| 21 | received effective on the date immediately preceding the | ||||||
| 22 | date that the
Department implements the new payment | ||||||
| 23 | methodology, the nursing component rate
per patient day for | ||||||
| 24 | the facility shall be adjusted.
| ||||||
| 25 | (C) Notwithstanding paragraphs (A) and (B), the | ||||||
| 26 | nursing component rate per
patient day for the facility | ||||||
| |||||||
| |||||||
| 1 | shall be adjusted subject to appropriations
provided by the | ||||||
| 2 | General Assembly.
| ||||||
| 3 | For facilities licensed by the Department of Public Health | ||||||
| 4 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 5 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 6 | Age 22 facilities, the rates taking
effect on March 1, 2001 | ||||||
| 7 | shall include a statewide increase of 7.85%, as
defined by the | ||||||
| 8 | Department.
| ||||||
| 9 | Notwithstanding any other provision of this Section, for | ||||||
| 10 | facilities licensed by the Department of Public Health under | ||||||
| 11 | the
Nursing Home Care Act as skilled nursing facilities or | ||||||
| 12 | intermediate care
facilities, the numerator of the ratio used | ||||||
| 13 | by the Department of Healthcare and Family Services to compute | ||||||
| 14 | the rate payable under this Section using the Minimum Data Set | ||||||
| 15 | (MDS) methodology shall incorporate the following annual | ||||||
| 16 | amounts as the additional funds appropriated to the Department | ||||||
| 17 | specifically to pay for rates based on the MDS nursing | ||||||
| 18 | component methodology in excess of the funding in effect on | ||||||
| 19 | December 31, 2006: | ||||||
| 20 | (i) For rates taking effect January 1, 2007, | ||||||
| 21 | $60,000,000. | ||||||
| 22 | (ii) For rates taking effect January 1, 2008, | ||||||
| 23 | $110,000,000. | ||||||
| 24 | (iii) For rates taking effect January 1, 2009, | ||||||
| 25 | $194,000,000. | ||||||
| 26 | Notwithstanding any other provision of this Section, for | ||||||
| |||||||
| |||||||
| 1 | facilities licensed by the Department of Public Health under | ||||||
| 2 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
| 3 | intermediate care facilities, the support component of the | ||||||
| 4 | rates taking effect on January 1, 2008 shall be computed using | ||||||
| 5 | the most recent cost reports on file with the Department of | ||||||
| 6 | Healthcare and Family Services no later than April 1, 2005, | ||||||
| 7 | updated for inflation to January 1, 2006. | ||||||
| 8 | For facilities licensed by the Department of Public Health | ||||||
| 9 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 10 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 11 | Age 22 facilities, the rates taking
effect on April 1, 2002 | ||||||
| 12 | shall include a statewide increase of 2.0%, as
defined by the | ||||||
| 13 | Department.
This increase terminates on July 1, 2002;
beginning | ||||||
| 14 | July 1, 2002 these rates are reduced to the level of the rates
| ||||||
| 15 | in effect on March 31, 2002, as defined by the Department.
| ||||||
| 16 | For facilities licensed by the Department of Public Health | ||||||
| 17 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
| 18 | or intermediate care
facilities, the rates taking effect on | ||||||
| 19 | July 1, 2001 shall be computed using the most recent cost | ||||||
| 20 | reports
on file with the Department of Public Aid no later than | ||||||
| 21 | April 1, 2000,
updated for inflation to January 1, 2001. For | ||||||
| 22 | rates effective July 1, 2001
only, rates shall be the greater | ||||||
| 23 | of the rate computed for July 1, 2001
or the rate effective on | ||||||
| 24 | June 30, 2001.
| ||||||
| 25 | Notwithstanding any other provision of this Section, for | ||||||
| 26 | facilities
licensed by the Department of Public Health under | ||||||
| |||||||
| |||||||
| 1 | the Nursing Home Care Act
as skilled nursing facilities or | ||||||
| 2 | intermediate care facilities, the Illinois
Department shall | ||||||
| 3 | determine by rule the rates taking effect on July 1, 2002,
| ||||||
| 4 | which shall be 5.9% less than the rates in effect on June 30, | ||||||
| 5 | 2002.
| ||||||
| 6 | Notwithstanding any other provision of this Section, for | ||||||
| 7 | facilities
licensed by the Department of Public Health under | ||||||
| 8 | the Nursing Home Care Act as
skilled nursing
facilities or | ||||||
| 9 | intermediate care facilities, if the payment methodologies | ||||||
| 10 | required under Section 5A-12 and the waiver granted under 42 | ||||||
| 11 | CFR 433.68 are approved by the United States Centers for | ||||||
| 12 | Medicare and Medicaid Services, the rates taking effect on July | ||||||
| 13 | 1, 2004 shall be 3.0% greater than the rates in effect on June | ||||||
| 14 | 30, 2004. These rates shall take
effect only upon approval and
| ||||||
| 15 | implementation of the payment methodologies required under | ||||||
| 16 | Section 5A-12.
| ||||||
| 17 | Notwithstanding any other provisions of this Section, for | ||||||
| 18 | facilities licensed by the Department of Public Health under | ||||||
| 19 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
| 20 | intermediate care facilities, the rates taking effect on | ||||||
| 21 | January 1, 2005 shall be 3% more than the rates in effect on | ||||||
| 22 | December 31, 2004.
| ||||||
| 23 | Notwithstanding any other provision of this Section, for | ||||||
| 24 | facilities licensed by the Department of Public Health under | ||||||
| 25 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
| 26 | intermediate care facilities, effective January 1, 2009, the | ||||||
| |||||||
| |||||||
| 1 | per diem support component of the rates effective on January 1, | ||||||
| 2 | 2008, computed using the most recent cost reports on file with | ||||||
| 3 | the Department of Healthcare and Family Services no later than | ||||||
| 4 | April 1, 2005, updated for inflation to January 1, 2006, shall | ||||||
| 5 | be increased to the amount that would have been derived using | ||||||
| 6 | standard Department of Healthcare and Family Services methods, | ||||||
| 7 | procedures, and inflators. | ||||||
| 8 | Notwithstanding any other provisions of this Section, for | ||||||
| 9 | facilities licensed by the Department of Public Health under | ||||||
| 10 | the Nursing Home Care Act as intermediate care facilities that | ||||||
| 11 | are federally defined as Institutions for Mental Disease, a | ||||||
| 12 | socio-development component rate equal to 6.6% of the | ||||||
| 13 | facility's nursing component rate as of January 1, 2006 shall | ||||||
| 14 | be established and paid effective July 1, 2006. The | ||||||
| 15 | socio-development component of the rate shall be increased by a | ||||||
| 16 | factor of 2.53 on the first day of the month that begins at | ||||||
| 17 | least 45 days after January 11, 2008 (the effective date of | ||||||
| 18 | Public Act 95-707). As of August 1, 2008, the socio-development | ||||||
| 19 | component rate shall be equal to 6.6% of the facility's nursing | ||||||
| 20 | component rate as of January 1, 2006, multiplied by a factor of | ||||||
| 21 | 3.53. The Illinois Department may by rule adjust these | ||||||
| 22 | socio-development component rates, but in no case may such | ||||||
| 23 | rates be diminished.
| ||||||
| 24 | For facilities
licensed
by the
Department of Public Health | ||||||
| 25 | under the Nursing Home Care Act as Intermediate
Care for
the | ||||||
| 26 | Developmentally Disabled facilities or as long-term care | ||||||
| |||||||
| |||||||
| 1 | facilities for
residents under 22 years of age, the rates | ||||||
| 2 | taking effect on July 1,
2003 shall
include a statewide | ||||||
| 3 | increase of 4%, as defined by the Department.
| ||||||
| 4 | For facilities licensed by the Department of Public Health | ||||||
| 5 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
| 6 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
| 7 | Age 22 facilities, the rates taking
effect on the first day of | ||||||
| 8 | the month that begins at least 45 days after the effective date | ||||||
| 9 | of this amendatory Act of the 95th General Assembly shall | ||||||
| 10 | include a statewide increase of 2.5%, as
defined by the | ||||||
| 11 | Department. | ||||||
| 12 | Notwithstanding any other provision of this Section, for | ||||||
| 13 | facilities licensed by the Department of Public Health under | ||||||
| 14 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
| 15 | intermediate care facilities, effective January 1, 2005, | ||||||
| 16 | facility rates shall be increased by the difference between (i) | ||||||
| 17 | a facility's per diem property, liability, and malpractice | ||||||
| 18 | insurance costs as reported in the cost report filed with the | ||||||
| 19 | Department of Public Aid and used to establish rates effective | ||||||
| 20 | July 1, 2001 and (ii) those same costs as reported in the | ||||||
| 21 | facility's 2002 cost report. These costs shall be passed | ||||||
| 22 | through to the facility without caps or limitations, except for | ||||||
| 23 | adjustments required under normal auditing procedures.
| ||||||
| 24 | Rates established effective each July 1 shall govern | ||||||
| 25 | payment
for services rendered throughout that fiscal year, | ||||||
| 26 | except that rates
established on July 1, 1996 shall be | ||||||
| |||||||
| |||||||
| 1 | increased by 6.8% for services
provided on or after January 1, | ||||||
| 2 | 1997. Such rates will be based
upon the rates calculated for | ||||||
| 3 | the year beginning July 1, 1990, and for
subsequent years | ||||||
| 4 | thereafter until June 30, 2001 shall be based on the
facility | ||||||
| 5 | cost reports
for the facility fiscal year ending at any point | ||||||
| 6 | in time during the previous
calendar year, updated to the | ||||||
| 7 | midpoint of the rate year. The cost report
shall be on file | ||||||
| 8 | with the Department no later than April 1 of the current
rate | ||||||
| 9 | year. Should the cost report not be on file by April 1, the | ||||||
| 10 | Department
shall base the rate on the latest cost report filed | ||||||
| 11 | by each skilled care
facility and intermediate care facility, | ||||||
| 12 | updated to the midpoint of the
current rate year. In | ||||||
| 13 | determining rates for services rendered on and after
July 1, | ||||||
| 14 | 1985, fixed time shall not be computed at less than zero. The
| ||||||
| 15 | Department shall not make any alterations of regulations which | ||||||
| 16 | would reduce
any component of the Medicaid rate to a level | ||||||
| 17 | below what that component would
have been utilizing in the rate | ||||||
| 18 | effective on July 1, 1984.
| ||||||
| 19 | (2) Shall take into account the actual costs incurred by | ||||||
| 20 | facilities
in providing services for recipients of skilled | ||||||
| 21 | nursing and intermediate
care services under the medical | ||||||
| 22 | assistance program.
| ||||||
| 23 | (3) Shall take into account the medical and psycho-social
| ||||||
| 24 | characteristics and needs of the patients.
| ||||||
| 25 | (4) Shall take into account the actual costs incurred by | ||||||
| 26 | facilities in
meeting licensing and certification standards | ||||||
| |||||||
| |||||||
| 1 | imposed and prescribed by the
State of Illinois, any of its | ||||||
| 2 | political subdivisions or municipalities and by
the U.S. | ||||||
| 3 | Department of Health and Human Services pursuant to Title XIX | ||||||
| 4 | of the
Social Security Act.
| ||||||
| 5 | The Department of Healthcare and Family Services
shall | ||||||
| 6 | develop precise standards for
payments to reimburse nursing | ||||||
| 7 | facilities for any utilization of
appropriate rehabilitative | ||||||
| 8 | personnel for the provision of rehabilitative
services which is | ||||||
| 9 | authorized by federal regulations, including
reimbursement for | ||||||
| 10 | services provided by qualified therapists or qualified
| ||||||
| 11 | assistants, and which is in accordance with accepted | ||||||
| 12 | professional
practices. Reimbursement also may be made for | ||||||
| 13 | utilization of other
supportive personnel under appropriate | ||||||
| 14 | supervision.
| ||||||
| 15 | (Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707, | ||||||
| 16 | eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09; | ||||||
| 17 | 96-339, eff. 7-1-10; revised 10-23-09.)
| ||||||
| 18 | Section 95. No acceleration or delay. Where this Act makes | ||||||
| 19 | changes in a statute that is represented in this Act by text | ||||||
| 20 | that is not yet or no longer in effect (for example, a Section | ||||||
| 21 | represented by multiple versions), the use of that text does | ||||||
| 22 | not accelerate or delay the taking effect of (i) the changes | ||||||
| 23 | made by this Act or (ii) provisions derived from any other | ||||||
| 24 | Public Act.
| ||||||
