Bill Text: IL SB3526 | 2019-2020 | 101st General Assembly | Introduced
Bill Title: Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, in applying the regional wage adjuster component of the RUG-IV 48 reimbursement methodology, no adjuster shall be lower than 0.95. Effective immediately.
Spectrum: Partisan Bill (Democrat 8-0)
Status: (Failed) 2021-01-13 - Session Sine Die [SB3526 Detail]
Download: Illinois-2019-SB3526-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 5-5.2 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 the | ||||||||||||||||||||||||
13 | 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 as | ||||||
7 | of 30 days prior to the beginning of the rate period in the | ||||||
8 | Department's Medicaid Management Information System (MMIS) | ||||||
9 | as present on the last day of the second quarter preceding | ||||||
10 | the rate period based upon the Assessment Reference Date of | ||||||
11 | the Minimum Data Set (MDS). | ||||||
12 | (3) Regional wage adjustors based on the Health Service | ||||||
13 | Areas (HSA) groupings and adjusters in effect on April 30, | ||||||
14 | 2012 shall be included , except no adjuster shall be lower | ||||||
15 | than 0.95 . | ||||||
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 the | ||||||
9 | exclusion of nursing homes defined in paragraph (5). | ||||||
10 | (2) For each nursing home with Medicaid residents as | ||||||
11 | indicated by the MDS data defined in paragraph (4), | ||||||
12 | weighted days adjusted for case mix and regional wage | ||||||
13 | adjustment shall be calculated. For each home this | ||||||
14 | calculation is the product of: | ||||||
15 | (A) Base year resident days as calculated in | ||||||
16 | subparagraph (A) of paragraph (1). | ||||||
17 | (B) The nursing home's regional wage adjustor | ||||||
18 | based on the Health Service Areas (HSA) groupings and | ||||||
19 | adjustors in effect on April 30, 2012. | ||||||
20 | (C) Facility weighted case mix which is the number | ||||||
21 | of Medicaid residents as indicated by the MDS data | ||||||
22 | defined in paragraph (4) multiplied by the associated | ||||||
23 | case weight for the RUG-IV 48 grouper model using | ||||||
24 | standard RUG-IV procedures for index maximization. | ||||||
25 | (D) The sum of the products calculated for each | ||||||
26 | nursing home in subparagraphs (A) through (C) above |
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1 | shall be the base year case mix, rate adjusted weighted | ||||||
2 | days. | ||||||
3 | (3) The Statewide RUG-IV nursing base per diem rate: | ||||||
4 | (A) on January 1, 2014 shall be the quotient of the | ||||||
5 | paragraph (1) divided by the sum calculated under | ||||||
6 | subparagraph (D) of paragraph (2); and | ||||||
7 | (B) on and after July 1, 2014, shall be the amount | ||||||
8 | calculated under subparagraph (A) of this paragraph | ||||||
9 | (3) plus $1.76. | ||||||
10 | (4) Minimum Data Set (MDS) comprehensive assessments | ||||||
11 | for Medicaid residents on the last day of the quarter used | ||||||
12 | to establish the base rate. | ||||||
13 | (5) Nursing facilities designated as of July 1, 2012 by | ||||||
14 | the Department as "Institutions for Mental Disease" shall | ||||||
15 | be excluded from all calculations under this subsection. | ||||||
16 | The data from these facilities shall not be used in the | ||||||
17 | computations described in paragraphs (1) through (4) above | ||||||
18 | to establish the base rate. | ||||||
19 | (e) Beginning July 1, 2014, the Department shall allocate | ||||||
20 | funding in the amount up to $10,000,000 for per diem add-ons to | ||||||
21 | the RUGS methodology for dates of service on and after July 1, | ||||||
22 | 2014: | ||||||
23 | (1) $0.63 for each resident who scores in I4200 | ||||||
24 | Alzheimer's Disease or I4800 non-Alzheimer's Dementia. | ||||||
25 | (2) $2.67 for each resident who scores either a "1" or | ||||||
26 | "2" in any items S1200A through S1200I and also scores in |
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1 | RUG groups PA1, PA2, BA1, or BA2. | ||||||
2 | (e-1) (Blank). | ||||||
3 | (e-2) For dates of services beginning January 1, 2014, the | ||||||
4 | RUG-IV nursing component per diem for a nursing home shall be | ||||||
5 | the product of the statewide RUG-IV nursing base per diem rate, | ||||||
6 | the facility average case mix index, and the regional wage | ||||||
7 | adjustor. Transition rates for services provided between | ||||||
8 | January 1, 2014 and December 31, 2014 shall be as follows: | ||||||
9 | (1) The transition RUG-IV per diem nursing rate for | ||||||
10 | nursing homes whose rate calculated in this subsection | ||||||
11 | (e-2) is greater than the nursing component rate in effect | ||||||
12 | July 1, 2012 shall be paid the sum of: | ||||||
13 | (A) The nursing component rate in effect July 1, | ||||||
14 | 2012; plus | ||||||
15 | (B) The difference of the RUG-IV nursing component | ||||||
16 | per diem calculated for the current quarter minus the | ||||||
17 | nursing component rate in effect July 1, 2012 | ||||||
18 | multiplied by 0.88. | ||||||
19 | (2) The transition RUG-IV per diem nursing rate for | ||||||
20 | nursing homes whose rate calculated in this subsection | ||||||
21 | (e-2) is less than the nursing component rate in effect | ||||||
22 | July 1, 2012 shall be paid the sum of: | ||||||
23 | (A) The nursing component rate in effect July 1, | ||||||
24 | 2012; plus | ||||||
25 | (B) The difference of the RUG-IV nursing component | ||||||
26 | per diem calculated for the current quarter minus the |
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1 | nursing component rate in effect July 1, 2012 | ||||||
2 | multiplied by 0.13. | ||||||
3 | (f) Notwithstanding any other provision of this Code, on | ||||||
4 | and after July 1, 2012, reimbursement rates associated with the | ||||||
5 | nursing or support components of the current nursing facility | ||||||
6 | rate methodology shall not increase beyond the level effective | ||||||
7 | May 1, 2011 until a new reimbursement system based on the RUGs | ||||||
8 | IV 48 grouper model has been fully operationalized. | ||||||
9 | (g) Notwithstanding any other provision of this Code, on | ||||||
10 | and after July 1, 2012, for facilities not designated by the | ||||||
11 | Department of Healthcare and Family Services as "Institutions | ||||||
12 | for Mental Disease", rates effective May 1, 2011 shall be | ||||||
13 | adjusted as follows: | ||||||
14 | (1) Individual nursing rates for residents classified | ||||||
15 | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | ||||||
16 | ending March 31, 2012 shall be reduced by 10%; | ||||||
17 | (2) Individual nursing rates for residents classified | ||||||
18 | in all other RUG IV groups shall be reduced by 1.0%; | ||||||
19 | (3) Facility rates for the capital and support | ||||||
20 | components shall be reduced by 1.7%. | ||||||
21 | (h) Notwithstanding any other provision of this Code, on | ||||||
22 | and after July 1, 2012, nursing facilities designated by the | ||||||
23 | Department of Healthcare and Family Services as "Institutions | ||||||
24 | for Mental Disease" and "Institutions for Mental Disease" that | ||||||
25 | are facilities licensed under the Specialized Mental Health | ||||||
26 | Rehabilitation Act of 2013 shall have the nursing, |
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1 | socio-developmental, capital, and support components of their | ||||||
2 | reimbursement rate effective May 1, 2011 reduced in total by | ||||||
3 | 2.7%. | ||||||
4 | (i) On and after July 1, 2014, the reimbursement rates for | ||||||
5 | the support component of the nursing facility rate for | ||||||
6 | facilities licensed under the Nursing Home Care Act as skilled | ||||||
7 | or intermediate care facilities shall be the rate in effect on | ||||||
8 | June 30, 2014 increased by 8.17%. | ||||||
9 | (j) Notwithstanding any other provision of law, subject to | ||||||
10 | federal approval, effective July 1, 2019, sufficient funds | ||||||
11 | shall be allocated for changes to rates for facilities licensed | ||||||
12 | under the Nursing Home Care Act as skilled nursing facilities | ||||||
13 | or intermediate care facilities for dates of services on and | ||||||
14 | after July 1, 2019: (i) to establish a per diem add-on to the | ||||||
15 | direct care per diem rate not to exceed $70,000,000 annually in | ||||||
16 | the aggregate taking into account federal matching funds for | ||||||
17 | the purpose of addressing the facility's unique staffing needs, | ||||||
18 | adjusted quarterly and distributed by a weighted formula based | ||||||
19 | on Medicaid bed days on the last day of the second quarter | ||||||
20 | preceding the quarter for which the rate is being adjusted; and | ||||||
21 | (ii) in an amount not to exceed $170,000,000 annually in the | ||||||
22 | aggregate taking into account federal matching funds to permit | ||||||
23 | the support component of the nursing facility rate to be | ||||||
24 | updated as follows: | ||||||
25 | (1) 80%, or $136,000,000, of the funds shall be used to | ||||||
26 | update each facility's rate in effect on June 30, 2019 |
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1 | using the most recent cost reports on file, which have had | ||||||
2 | a limited review conducted by the Department of Healthcare | ||||||
3 | and Family Services and will not hold up enacting the rate | ||||||
4 | increase, with the Department of Healthcare and Family | ||||||
5 | Services and taking into account subsection (i). | ||||||
6 | (2) After completing the calculation in paragraph (1), | ||||||
7 | any facility whose rate is less than the rate in effect on | ||||||
8 | June 30, 2019 shall have its rate restored to the rate in | ||||||
9 | effect on June 30, 2019 from the 20% of the funds set | ||||||
10 | aside. | ||||||
11 | (3) The remainder of the 20%, or $34,000,000, shall be | ||||||
12 | used to increase each facility's rate by an equal | ||||||
13 | percentage. | ||||||
14 | To implement item (i) in this subsection, facilities shall | ||||||
15 | file quarterly reports documenting compliance with its | ||||||
16 | annually approved staffing plan, which shall permit compliance | ||||||
17 | with Section 3-202.05 of the Nursing Home Care Act. A facility | ||||||
18 | that fails to meet the benchmarks and dates contained in the | ||||||
19 | plan may have its add-on adjusted in the quarter following the | ||||||
20 | quarterly review. Nothing in this Section shall limit the | ||||||
21 | ability of the facility to appeal a ruling of non-compliance | ||||||
22 | and a subsequent reduction to the add-on. Funds adjusted for | ||||||
23 | noncompliance shall be maintained in the Long-Term Care | ||||||
24 | Provider Fund and accounted for separately. At the end of each | ||||||
25 | fiscal year, these funds shall be made available to facilities | ||||||
26 | for special staffing projects. |
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1 | In order to provide for the expeditious and timely
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2 | implementation of the provisions of Public Act 101-10 this | ||||||
3 | amendatory Act of the
101st General Assembly , emergency rules | ||||||
4 | to implement any provision of Public Act 101-10 this amendatory | ||||||
5 | Act of the 101st General Assembly may be adopted in accordance | ||||||
6 | with this subsection by the agency charged with administering | ||||||
7 | that provision or
initiative. The agency shall simultaneously | ||||||
8 | file emergency rules and permanent rules to ensure that there | ||||||
9 | is no interruption in administrative guidance. The 150-day | ||||||
10 | limitation of the effective period of emergency rules does not | ||||||
11 | apply to rules adopted under this
subsection, and the effective | ||||||
12 | period may continue through
June 30, 2021. The 24-month | ||||||
13 | limitation on the adoption of
emergency rules does not apply to | ||||||
14 | rules adopted under this
subsection. The adoption of emergency | ||||||
15 | rules authorized by this subsection is deemed to be necessary | ||||||
16 | for the public interest, safety, and welfare. | ||||||
17 | (k) (j) During the first quarter of State Fiscal Year 2020, | ||||||
18 | the Department of Healthcare of Family Services must convene a | ||||||
19 | technical advisory group consisting of members of all trade | ||||||
20 | associations representing Illinois skilled nursing providers | ||||||
21 | to discuss changes necessary with federal implementation of | ||||||
22 | Medicare's Patient-Driven Payment Model. Implementation of | ||||||
23 | Medicare's Patient-Driven Payment Model shall, by September 1, | ||||||
24 | 2020, end the collection of the MDS data that is necessary to | ||||||
25 | maintain the current RUG-IV Medicaid payment methodology. The | ||||||
26 | technical advisory group must consider a revised reimbursement |
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1 | methodology that takes into account transparency, | ||||||
2 | accountability, actual staffing as reported under the | ||||||
3 | federally required Payroll Based Journal system, changes to the | ||||||
4 | minimum wage, adequacy in coverage of the cost of care, and a | ||||||
5 | quality component that rewards quality improvements. | ||||||
6 | (Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19; | ||||||
7 | revised 9-18-19.)
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8 | Section 99. Effective date. This Act takes effect upon | ||||||
9 | becoming law.
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