093_HB2657enr

 
HB2657 Enrolled                      LRB093 04135 RCE 04178 b

 1        AN ACT in relation to budget implementation.

 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  by  the  Department  of  Public
15    Health  under  the Nursing Home Care Act as Intermediate Care
16    for the Developmentally Disabled facilities, Long  Term  Care
17    for  Under  Age 22 facilities, Skilled Nursing facilities, or
18    Intermediate Care facilities  under  the  medical  assistance
19    program  shall  be  prospectively established annually on the
20    basis  of  historical,  financial,   and   statistical   data
21    reflecting  actual  costs  from  prior  years, which shall be
22    applied to the current rate year and updated  for  inflation,
23    except  that  the  capital cost element for newly constructed
24    facilities  shall  be  based  upon  projected  budgets.   The
25    annually established payment rate shall take effect on July 1
26    in 1984 and subsequent years.  No rate increase and no update
27    for inflation shall be provided on or after July 1, 1994  and
28    before July 1, 2004, unless specifically provided for in this
29    Section.
30        For  facilities  licensed  by  the  Department  of Public
31    Health under the Nursing Home Care Act as  Intermediate  Care
 
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 1    for the Developmentally Disabled facilities or Long Term Care
 2    for  Under Age 22 facilities, the rates taking effect on July
 3    1, 1998 shall include an  increase  of  3%.   For  facilities
 4    licensed by the Department of Public Health under the Nursing
 5    Home  Care  Act as Skilled Nursing facilities or Intermediate
 6    Care facilities, the rates taking  effect  on  July  1,  1998
 7    shall  include an increase of 3% plus $1.10 per resident-day,
 8    as defined by the Department.
 9        For facilities  licensed  by  the  Department  of  Public
10    Health  under  the Nursing Home Care Act as Intermediate Care
11    for the Developmentally Disabled facilities or Long Term Care
12    for Under Age 22 facilities, the rates taking effect on  July
13    1,  1999  shall  include  an  increase of 1.6% plus $3.00 per
14    resident-day, as defined by the Department.   For  facilities
15    licensed by the Department of Public Health under the Nursing
16    Home  Care  Act as Skilled Nursing facilities or Intermediate
17    Care facilities, the rates taking  effect  on  July  1,  1999
18    shall  include an increase of 1.6% and, for services provided
19    on or after October 1, 1999, shall be increased by $4.00  per
20    resident-day, as defined by the Department.
21        For  facilities  licensed  by  the  Department  of Public
22    Health under the Nursing Home Care Act as  Intermediate  Care
23    for the Developmentally Disabled facilities or Long Term Care
24    for  Under Age 22 facilities, the rates taking effect on July
25    1, 2000 shall include an increase of 2.5%  per  resident-day,
26    as defined by the Department.  For facilities licensed by the
27    Department  of  Public Health under the Nursing Home Care Act
28    as  Skilled   Nursing   facilities   or   Intermediate   Care
29    facilities,  the  rates  taking  effect on July 1, 2000 shall
30    include an increase of 2.5% per resident-day, as  defined  by
31    the Department.
32        For  facilities  licensed  by  the  Department  of Public
33    Health under the Nursing Home Care  Act  as  skilled  nursing
34    facilities  or  intermediate  care  facilities, a new payment
 
HB2657 Enrolled            -3-       LRB093 04135 RCE 04178 b
 1    methodology must be implemented for the nursing component  of
 2    the rate effective July 1, 2003. The Department of Public Aid
 3    shall  develop  the new payment methodology using the Minimum
 4    Data Set (MDS)  as  the  instrument  to  collect  information
 5    concerning  nursing  home  resident  condition  necessary  to
 6    compute  the rate. The Department of Public Aid shall develop
 7    the new payment methodology  to  meet  the  unique  needs  of
 8    Illinois  nursing  home  residents while remaining subject to
 9    the  appropriations  provided  by  the  General  Assembly.  A
10    transition period from the payment methodology in  effect  on
11    June 30, 2003 to the payment methodology in effect on July 1,
12    2003  shall  be  provided  for a period not exceeding 2 years
13    after  implementation  of  the  new  payment  methodology  as
14    follows:
15             (A)  For a  facility  that  would  receive  a  lower
16        nursing  component  rate  per  patient  day under the new
17        system than the facility received effective on  the  date
18        immediately   preceding  the  date  that  the  Department
19        implements  the  new  payment  methodology,  the  nursing
20        component rate per patient day for the facility shall  be
21        held  at  the  level  in  effect  on the date immediately
22        preceding the date that the Department implements the new
23        payment methodology until a higher nursing component rate
24        of reimbursement is achieved by that facility.
25             (B)  For a facility  that  would  receive  a  higher
26        nursing  component rate per patient day under the payment
27        methodology in effect on July 1, 2003 than  the  facility
28        received  effective on the date immediately preceding the
29        date that  the  Department  implements  the  new  payment
30        methodology,  the  nursing component rate per patient day
31        for the facility shall be adjusted.
32             (C)  Notwithstanding paragraphs  (A)  and  (B),  the
33        nursing  component  rate per patient day for the facility
34        shall be adjusted subject to appropriations  provided  by
 
HB2657 Enrolled            -4-       LRB093 04135 RCE 04178 b
 1        the General Assembly.
 2        For  facilities  licensed  by  the  Department  of Public
 3    Health under the Nursing Home Care Act as  Intermediate  Care
 4    for the Developmentally Disabled facilities or Long Term Care
 5    for Under Age 22 facilities, the rates taking effect on March
 6    1,  2001  shall  include  a  statewide  increase of 7.85%, as
 7    defined by the Department.
 8        For facilities  licensed  by  the  Department  of  Public
 9    Health  under  the Nursing Home Care Act as Intermediate Care
10    for the Developmentally Disabled facilities or Long Term Care
11    for Under Age 22 facilities, the rates taking effect on April
12    1, 2002 shall  include  a  statewide  increase  of  2.0%,  as
13    defined  by  the Department. This increase terminates on July
14    1, 2002; beginning July 1, 2002 these rates  are  reduced  to
15    the  level  of  the  rates  in  effect  on March 31, 2002, as
16    defined by the Department.
17        For facilities  licensed  by  the  Department  of  Public
18    Health  under  the  Nursing  Home Care Act as skilled nursing
19    facilities or intermediate care facilities, the rates  taking
20    effect  on  July  1,  2001  shall  be computed using the most
21    recent cost reports on file with the Department of Public Aid
22    no later than April 1, 2000, updated for inflation to January
23    1, 2001.  For rates effective July 1, 2001 only, rates  shall
24    be  the  greater of the rate computed for July 1, 2001 or the
25    rate effective on June 30, 2001.
26        Notwithstanding any other provision of this Section,  for
27    facilities  licensed by the Department of Public Health under
28    the Nursing Home Care Act as skilled  nursing  facilities  or
29    intermediate  care  facilities, the Illinois Department shall
30    determine by rule the rates taking effect on  July  1,  2002,
31    which shall be 5.9% less than the rates in effect on June 30,
32    2002.
33        For  facilities  licensed  by  the  Department  of Public
34    Health under the Nursing Home Care Act as  Intermediate  Care
 
HB2657 Enrolled            -5-       LRB093 04135 RCE 04178 b
 1    for  the  Developmentally Disabled facilities or as long-term
 2    care facilities for residents under  22  years  of  age,  the
 3    rates taking effect on July 1, 2003 shall include a statewide
 4    increase of 4%, as defined by the Department.
 5        Rates  established  effective  each  July  1 shall govern
 6    payment for services rendered throughout  that  fiscal  year,
 7    except  that  rates  established  on  July  1,  1996 shall be
 8    increased by 6.8% for services provided on or  after  January
 9    1,  1997.  Such rates will be based upon the rates calculated
10    for the year beginning July 1, 1990, and for subsequent years
11    thereafter until June 30, 2001 shall be based on the facility
12    cost reports for the facility fiscal year ending at any point
13    in time during the previous calendar  year,  updated  to  the
14    midpoint  of the rate year.  The cost report shall be on file
15    with the Department no later than April 1 of the current rate
16    year.  Should the cost report not be on file by April 1,  the
17    Department  shall  base  the  rate  on the latest cost report
18    filed by each skilled care  facility  and  intermediate  care
19    facility,  updated  to the midpoint of the current rate year.
20    In determining rates for services rendered on and after  July
21    1,  1985, fixed time shall not be computed at less than zero.
22    The Department shall not make any alterations of  regulations
23    which  would  reduce  any component of the Medicaid rate to a
24    level below what that component would have been utilizing  in
25    the rate effective on July 1, 1984.
26        (2)  Shall take into account the actual costs incurred by
27    facilities  in  providing  services for recipients of skilled
28    nursing and intermediate  care  services  under  the  medical
29    assistance program.
30        (3)  Shall    take   into   account   the   medical   and
31    psycho-social characteristics and needs of the patients.
32        (4)  Shall take into account the actual costs incurred by
33    facilities in meeting licensing and  certification  standards
34    imposed  and  prescribed by the State of Illinois, any of its
 
HB2657 Enrolled            -6-       LRB093 04135 RCE 04178 b
 1    political subdivisions or  municipalities  and  by  the  U.S.
 2    Department of Health and Human Services pursuant to Title XIX
 3    of the Social Security Act.
 4        The  Department  of  Public  Aid  shall  develop  precise
 5    standards  for  payments  to reimburse nursing facilities for
 6    any utilization of appropriate rehabilitative  personnel  for
 7    the  provision of rehabilitative services which is authorized
 8    by federal regulations, including reimbursement for  services
 9    provided by qualified therapists or qualified assistants, and
10    which  is in accordance with accepted professional practices.
11    Reimbursement also may  be  made  for  utilization  of  other
12    supportive personnel under appropriate supervision.
13    (Source:  P.A.  92-10,  eff.  6-11-01;  92-31,  eff. 6-28-01;
14    92-597, eff. 6-28-02;  92-651,  eff.  7-11-02;  92-848,  eff.
15    1-1-03; 93-20, eff. 6-20-03.)

16        Section  99.  Effective date.  This Act takes effect upon
17    becoming law.