093_HB0304

 
                                     LRB093 06390 DRJ 06510 b

 1        AN ACT in relation to public aid.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 5. The Illinois Public Aid  Code  is  amended  by
 5    changing Section 5-5.4 as follows:

 6        (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
 7        Sec.  5-5.4.  Standards of Payment - Department of Public
 8    Aid.  The Department of Public Aid shall develop standards of
 9    payment of skilled nursing and intermediate care services  in
10    facilities providing such services under this Article which:
11        (1)  Provide   for  the  determination  of  a  facility's
12    payment for skilled nursing and intermediate care services on
13    a prospective basis.  The amount of the payment rate for  all
14    nursing  facilities  certified  under  the medical assistance
15    program shall be prospectively established  annually  on  the
16    basis   of   historical,   financial,  and  statistical  data
17    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
21    annually established payment rate shall take effect on July 1
22    in 1984 and subsequent years.  No rate increase and no update
23    for  inflation shall be provided on or after July 1, 1994 and
24    before July 1, 2003, unless specifically provided for in this
25    Section.
26        For facilities  licensed  by  the  Department  of  Public
27    Health  under  the Nursing Home Care Act as Intermediate Care
28    for the Developmentally Disabled facilities or Long Term Care
29    for Under Age 22 facilities, the rates taking effect on  July
30    1,  1998  shall  include  an  increase of 3%.  For facilities
31    licensed by the Department of Public Health under the Nursing
 
                            -2-      LRB093 06390 DRJ 06510 b
 1    Home Care Act as Skilled Nursing facilities  or  Intermediate
 2    Care  facilities,  the  rates  taking  effect on July 1, 1998
 3    shall include an increase of 3% plus $1.10 per  resident-day,
 4    as defined by the Department.
 5        For  facilities  licensed  by  the  Department  of Public
 6    Health under the Nursing Home Care Act as  Intermediate  Care
 7    for the Developmentally Disabled facilities or Long Term Care
 8    for  Under Age 22 facilities, the rates taking effect on July
 9    1, 1999 shall include an increase  of  1.6%  plus  $3.00  per
10    resident-day,  as  defined by the Department.  For facilities
11    licensed by the Department of Public Health under the Nursing
12    Home Care Act as Skilled Nursing facilities  or  Intermediate
13    Care  facilities,  the  rates  taking  effect on July 1, 1999
14    shall include an increase of 1.6% and, for services  provided
15    on  or after October 1, 1999, shall be increased by $4.00 per
16    resident-day, as defined by the Department.
17        For facilities  licensed  by  the  Department  of  Public
18    Health  under  the Nursing Home Care Act as Intermediate Care
19    for the Developmentally Disabled facilities or Long Term Care
20    for Under Age 22 facilities, the rates taking effect on  July
21    1,  2000  shall include an increase of 2.5% per resident-day,
22    as defined by the Department.  For facilities licensed by the
23    Department of Public Health under the Nursing Home  Care  Act
24    as   Skilled   Nursing   facilities   or   Intermediate  Care
25    facilities, the rates taking effect on  July  1,  2000  shall
26    include  an  increase of 2.5% per resident-day, as defined by
27    the Department.
28        For facilities  licensed  by  the  Department  of  Public
29    Health  under  the  Nursing  Home Care Act as skilled nursing
30    facilities or intermediate care  facilities,  a  new  payment
31    methodology  must be implemented for the nursing component of
32    the rate effective July 1, 2003. The Department of Public Aid
33    shall develop the new payment methodology using  the  Minimum
34    Data  Set  (MDS)  as  the  instrument  to collect information
 
                            -3-      LRB093 06390 DRJ 06510 b
 1    concerning  nursing  home  resident  condition  necessary  to
 2    compute the rate. The Department of Public Aid shall  develop
 3    the  new  payment  methodology  to  meet  the unique needs of
 4    Illinois nursing home residents while  remaining  subject  to
 5    the  appropriations  provided  by  the  General  Assembly.  A
 6    transition  period  from the payment methodology in effect on
 7    June 30, 2003 to the payment methodology in effect on July 1,
 8    2003 shall be provided for a period  not  exceeding  2  years
 9    after  implementation  of  the  new  payment  methodology  as
10    follows:
11             (A)  For  a  facility  that  would  receive  a lower
12        nursing component rate per  patient  day  under  the  new
13        system  than  the facility received effective on the date
14        immediately  preceding  the  date  that  the   Department
15        implements  the  new  payment  methodology,  the  nursing
16        component  rate per patient day for the facility shall be
17        held at the level  in  effect  on  the  date  immediately
18        preceding the date that the Department implements the new
19        payment methodology until a higher nursing component rate
20        of reimbursement is achieved by that facility.
21             (B)  For  a  facility  that  would  receive a higher
22        nursing component rate per patient day under the  payment
23        methodology  in  effect on July 1, 2003 than the facility
24        received effective on the date immediately preceding  the
25        date  that  the  Department  implements  the  new payment
26        methodology, the nursing component rate per  patient  day
27        for the facility shall be adjusted.
28             (C)  Notwithstanding  paragraphs  (A)  and  (B), the
29        nursing component rate per patient day for  the  facility
30        shall  be  adjusted subject to appropriations provided by
31        the General Assembly.
32        For facilities  licensed  by  the  Department  of  Public
33    Health  under  the Nursing Home Care Act as Intermediate Care
34    for the Developmentally Disabled facilities or Long Term Care
 
                            -4-      LRB093 06390 DRJ 06510 b
 1    for Under Age 22 facilities, the rates taking effect on March
 2    1, 2001 shall include  a  statewide  increase  of  7.85%,  as
 3    defined by the Department.
 4        For  facilities  licensed  by  the  Department  of Public
 5    Health under the Nursing Home Care Act as  Intermediate  Care
 6    for the Developmentally Disabled facilities or Long Term Care
 7    for Under Age 22 facilities, the rates taking effect on April
 8    1,  2002  shall  include  a  statewide  increase  of 2.0%, as
 9    defined by the Department. This increase terminates  on  July
10    1,  2002;  beginning  July 1, 2002 these rates are reduced to
11    the level of the rates  in  effect  on  March  31,  2002,  as
12    defined by the Department.
13        For  facilities  licensed  by  the  Department  of Public
14    Health under the Nursing Home Care  Act  as  skilled  nursing
15    facilities  or intermediate care facilities, the rates taking
16    effect on July 1, 2001, and each subsequent year  thereafter,
17    shall  be computed using the most recent cost reports on file
18    with the Department of Public Aid  no  later  than  April  1,
19    2000,  updated  for  inflation to January 1, 2001.  For rates
20    effective July 1, 2001 only, rates shall be  the  greater  of
21    the  rate  computed for July 1, 2001 or the rate effective on
22    June 30, 2001.
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, the Illinois Department shall
27    determine by rule the rates taking effect on  July  1,  2002,
28    which shall be 5.9% less than the rates in effect on June 30,
29    2002.
30        On   and  after  July  1,  2003,  the  appropriation  for
31    facilities licensed under 77 Ill.  Adm.  Code  300.Subpart  T
32    (Facilities  Participating  in  Illinois Department of Public
33    Aid's Demonstration Program for Providing Services to Persons
34    with Mental Illness) shall be separate from the appropriation
 
                            -5-      LRB093 06390 DRJ 06510 b
 1    for all other facilities licensed by the Department of Public
 2    Health under the Nursing Home Care  Act  as  skilled  nursing
 3    facilities  or intermediate care facilities.  The rates for a
 4    facility licensed under 77 Ill. Adm. Code 300.Subpart T shall
 5    be limited to no more  than  7%  of  the  facility's  audited
 6    adjusted cost.
 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
11    1,  1997.  Such rates will be based upon the rates calculated
12    for 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
20    filed by each skilled care  facility  and  intermediate  care
21    facility,  updated  to the midpoint of the current rate year.
22    In determining rates for services rendered on and after  July
23    1,  1985, fixed time shall not be computed at less than zero.
24    The Department shall not make any alterations of  regulations
25    which  would  reduce  any component of the Medicaid rate to a
26    level below what that component would have been utilizing  in
27    the rate effective on July 1, 1984.
28        (2)  Shall take into account the actual costs incurred by
29    facilities  in  providing  services for recipients of skilled
30    nursing and intermediate  care  services  under  the  medical
31    assistance program.
32        (3)  Shall    take   into   account   the   medical   and
33    psycho-social characteristics and needs of the patients.
34        (4)  Shall take into account the actual costs incurred by
 
                            -6-      LRB093 06390 DRJ 06510 b
 1    facilities in meeting licensing and  certification  standards
 2    imposed  and  prescribed by the State of Illinois, any of its
 3    political subdivisions or  municipalities  and  by  the  U.S.
 4    Department of Health and Human Services pursuant to Title XIX
 5    of the Social Security Act.
 6        The  Department  of  Public  Aid  shall  develop  precise
 7    standards  for  payments  to reimburse nursing facilities for
 8    any utilization of appropriate rehabilitative  personnel  for
 9    the  provision of rehabilitative services which is authorized
10    by federal regulations, including reimbursement for  services
11    provided by qualified therapists or qualified assistants, and
12    which  is in accordance with accepted professional practices.
13    Reimbursement also may  be  made  for  utilization  of  other
14    supportive personnel under appropriate supervision.
15    (Source: P.A. 91-24, eff. 7-1-99; 91-712, eff. 7-1-00; 92-10,
16    eff.  6-11-01;  92-31,  eff.  6-28-01;  92-597, eff. 6-28-02;
17    92-651, eff. 7-11-02; 92-848, eff. 1-1-03; revised 9-20-02.)

18        Section 99.  Effective date.  This Act takes effect  upon
19    becoming law.