98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
SB1476

 

Introduced 2/6/2013, by Sen. Antonio Muņoz

 

SYNOPSIS AS INTRODUCED:
 
210 ILCS 45/3-202.05
305 ILCS 5/5-5.2  from Ch. 23, par. 5-5.2
305 ILCS 5/5-5.4  from Ch. 23, par. 5-5.4

    Amends the Nursing Home Care Act and the Illinois Public Aid Code. In the Nursing Home Care Act, eliminates a provision that certain minimum staffing ratio requirements shall remain in effect until an acuity based registered nurse requirement is promulgated by rule concurrent with the adoption of the Resource Utilization Group (RUG) classification-based payment methodology, as provided in the Illinois Public Aid Code. Provides that both the 25% licensed nurse requirement and 10% registered nurse requirement shall remain in effect until an acuity based licensed nurse requirement and registered nurse requirement are adopted in administrative rules subsequent to the implementation of the RUG classification-based payment methodology. Provides that an acuity based licensed nurse requirement and registered nurse requirement shall not be made effective before January 1, 2014. In the Illinois Public Aid Code, provides that the methodologies for Medicaid reimbursement of nursing services shall no longer be applicable for bills payable for nursing services rendered on or after a new reimbursement system based on the Resource Utilization Groups (RUGs) has been fully operationalized, which shall take effect for services provided on or after April 1, 2013 (instead of January 1, 2014). In provisions concerning Medicaid standards of payment to nursing facilities, provides that beginning April 1, 2013 (instead of January 1, 2014), the methodologies for reimbursement of nursing facility services shall no longer be applicable for services provided on or after April 1, 2013 (instead of January 1, 2014). Effective April 1, 2013.


LRB098 07061 DRJ 37120 b

FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1476LRB098 07061 DRJ 37120 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Nursing Home Care Act is amended by changing
5Section 3-202.05 as follows:
 
6    (210 ILCS 45/3-202.05)
7    Sec. 3-202.05. Staffing ratios effective July 1, 2010 and
8thereafter.
9    (a) For the purpose of computing staff to resident ratios,
10direct care staff shall include:
11        (1) registered nurses;
12        (2) licensed practical nurses;
13        (3) certified nurse assistants;
14        (4) psychiatric services rehabilitation aides;
15        (5) rehabilitation and therapy aides;
16        (6) psychiatric services rehabilitation coordinators;
17        (7) assistant directors of nursing;
18        (8) 50% of the Director of Nurses' time; and
19        (9) 30% of the Social Services Directors' time.
20    The Department shall, by rule, allow certain facilities
21subject to 77 Ill. Admin. Code 300.4000 and following (Subpart
22S) to utilize specialized clinical staff, as defined in rules,
23to count towards the staffing ratios.

 

 

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1    Within 120 days of the effective date of this amendatory
2Act of the 97th General Assembly, the Department shall
3promulgate rules specific to the staffing requirements for
4facilities federally defined as Institutions for Mental
5Disease. These rules shall recognize the unique nature of
6individuals with chronic mental health conditions, shall
7include minimum requirements for specialized clinical staff,
8including clinical social workers, psychiatrists,
9psychologists, and direct care staff set forth in paragraphs
10(4) through (6) and any other specialized staff which may be
11utilized and deemed necessary to count toward staffing ratios.
12    Within 120 days of the effective date of this amendatory
13Act of the 97th General Assembly, the Department shall
14promulgate rules specific to the staffing requirements for
15facilities licensed under the Specialized Mental Health
16Rehabilitation Act. These rules shall recognize the unique
17nature of individuals with chronic mental health conditions,
18shall include minimum requirements for specialized clinical
19staff, including clinical social workers, psychiatrists,
20psychologists, and direct care staff set forth in paragraphs
21(4) through (6) and any other specialized staff which may be
22utilized and deemed necessary to count toward staffing ratios.
23    (b) Beginning January 1, 2011, and thereafter, light
24intermediate care shall be staffed at the same staffing ratio
25as intermediate care.
26    (c) Facilities shall notify the Department within 60 days

 

 

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1after the effective date of this amendatory Act of the 96th
2General Assembly, in a form and manner prescribed by the
3Department, of the staffing ratios in effect on the effective
4date of this amendatory Act of the 96th General Assembly for
5both intermediate and skilled care and the number of residents
6receiving each level of care.
7    (d)(1) Effective July 1, 2010, for each resident needing
8skilled care, a minimum staffing ratio of 2.5 hours of nursing
9and personal care each day must be provided; for each resident
10needing intermediate care, 1.7 hours of nursing and personal
11care each day must be provided.
12    (2) Effective January 1, 2011, the minimum staffing ratios
13shall be increased to 2.7 hours of nursing and personal care
14each day for a resident needing skilled care and 1.9 hours of
15nursing and personal care each day for a resident needing
16intermediate care.
17    (3) Effective January 1, 2012, the minimum staffing ratios
18shall be increased to 3.0 hours of nursing and personal care
19each day for a resident needing skilled care and 2.1 hours of
20nursing and personal care each day for a resident needing
21intermediate care.
22    (4) Effective January 1, 2013, the minimum staffing ratios
23shall be increased to 3.4 hours of nursing and personal care
24each day for a resident needing skilled care and 2.3 hours of
25nursing and personal care each day for a resident needing
26intermediate care.

 

 

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1    (5) Effective January 1, 2014, the minimum staffing ratios
2shall be increased to 3.8 hours of nursing and personal care
3each day for a resident needing skilled care and 2.5 hours of
4nursing and personal care each day for a resident needing
5intermediate care.
6    (e) Ninety days after the effective date of this amendatory
7Act of the 97th General Assembly, a minimum of 25% of nursing
8and personal care time shall be provided by licensed nurses,
9with at least 10% of nursing and personal care time provided by
10registered nurses. These minimum requirements shall remain in
11effect until an acuity based registered nurse requirement is
12promulgated by rule concurrent with the adoption of the
13Resource Utilization Group classification-based payment
14methodology, as provided in Section 5-5.2 of the Illinois
15Public Aid Code. Registered nurses and licensed practical
16nurses employed by a facility in excess of these requirements
17may be used to satisfy the remaining 75% of the nursing and
18personal care time requirements. Notwithstanding this
19subsection, no staffing requirement in statute in effect on the
20effective date of this amendatory Act of the 97th General
21Assembly shall be reduced on account of this subsection. Both
22the 25% licensed nurse requirement and 10% registered nurse
23requirement shall remain in effect until an acuity based
24licensed nurse requirement and registered nurse requirement
25are adopted in administrative rules subsequent to the
26implementation of the Resource Utilization Group

 

 

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1classification-based payment methodology, as provided in
2Section 5-5.2 of the Illinois Public Aid Code. An acuity based
3licensed nurse requirement and registered nurse requirement
4shall not be made effective before January 1, 2014.
5(Source: P.A. 96-1372, eff. 7-29-10; 96-1504, eff. 1-27-11;
697-689, eff. 6-14-12.)
 
7    Section 10. The Illinois Public Aid Code is amended by
8changing Sections 5-5.2 and 5-5.4 as follows:
 
9    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
10    Sec. 5-5.2. Payment.
11    (a) All nursing facilities that are grouped pursuant to
12Section 5-5.1 of this Act shall receive the same rate of
13payment for similar services.
14    (b) It shall be a matter of State policy that the Illinois
15Department shall utilize a uniform billing cycle throughout the
16State for the long-term care providers.
17    (c) Notwithstanding any other provisions of this Code, the
18methodologies for reimbursement of nursing services as
19provided under this Article shall no longer be applicable for
20bills payable for nursing services rendered on or after a new
21reimbursement system based on the Resource Utilization Groups
22(RUGs) has been fully operationalized, which shall take effect
23for services provided on or after April 1, 2013 January 1,
242014.

 

 

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1    (d) A new nursing services reimbursement methodology
2utilizing RUGs IV 48 grouper model shall be established and may
3include an Illinois-specific default group, as needed. The new
4RUGs-based nursing services reimbursement methodology shall be
5resident-driven, facility-specific, and cost-based. Costs
6shall be annually rebased and case mix index quarterly updated.
7The methodology shall include regional wage adjustors based on
8the Health Service Areas (HSA) groupings in effect on April 30,
92012. The Department shall assign a case mix index to each
10resident class based on the Centers for Medicare and Medicaid
11Services staff time measurement study utilizing an index
12maximization approach.
13    (e) Notwithstanding any other provision of this Code, the
14Department shall by rule develop a reimbursement methodology
15reflective of the intensity of care and services requirements
16of low need residents in the lowest RUG IV groupers and
17corresponding regulations.
18    (f) Notwithstanding any other provision of this Code, on
19and after July 1, 2012, reimbursement rates associated with the
20nursing or support components of the current nursing facility
21rate methodology shall not increase beyond the level effective
22May 1, 2011 until a new reimbursement system based on the RUGs
23IV 48 grouper model has been fully operationalized.
24    (g) Notwithstanding any other provision of this Code, on
25and after July 1, 2012, for facilities not designated by the
26Department of Healthcare and Family Services as "Institutions

 

 

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1for Mental Disease", rates effective May 1, 2011 shall be
2adjusted as follows:
3        (1) Individual nursing rates for residents classified
4    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
5    ending March 31, 2012 shall be reduced by 10%;
6        (2) Individual nursing rates for residents classified
7    in all other RUG IV groups shall be reduced by 1.0%;
8        (3) Facility rates for the capital and support
9    components shall be reduced by 1.7%.
10    (h) Notwithstanding any other provision of this Code, on
11and after July 1, 2012, nursing facilities designated by the
12Department of Healthcare and Family Services as "Institutions
13for Mental Disease" and "Institutions for Mental Disease" that
14are facilities licensed under the Specialized Mental Health
15Rehabilitation Act shall have the nursing,
16socio-developmental, capital, and support components of their
17reimbursement rate effective May 1, 2011 reduced in total by
182.7%.
19(Source: P.A. 96-1530, eff. 2-16-11; 97-689, eff. 6-14-12.)
 
20    (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
21    Sec. 5-5.4. Standards of Payment - Department of Healthcare
22and Family Services. The Department of Healthcare and Family
23Services shall develop standards of payment of nursing facility
24and ICF/DD services in facilities providing such services under
25this Article which:

 

 

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1    (1) Provide for the determination of a facility's payment
2for nursing facility or ICF/DD services on a prospective basis.
3The amount of the payment rate for all nursing facilities
4certified by the Department of Public Health under the ID/DD
5Community Care Act or the Nursing Home Care Act as Intermediate
6Care for the Developmentally Disabled facilities, Long Term
7Care for Under Age 22 facilities, Skilled Nursing facilities,
8or Intermediate Care facilities under the medical assistance
9program shall be prospectively established annually on the
10basis of historical, financial, and statistical data
11reflecting actual costs from prior years, which shall be
12applied to the current rate year and updated for inflation,
13except that the capital cost element for newly constructed
14facilities shall be based upon projected budgets. The annually
15established payment rate shall take effect on July 1 in 1984
16and subsequent years. No rate increase and no update for
17inflation shall be provided on or after July 1, 1994 and before
18January 1, 2014, unless specifically provided for in this
19Section. The changes made by Public Act 93-841 extending the
20duration of the prohibition against a rate increase or update
21for inflation are effective retroactive to July 1, 2004.
22    For facilities licensed by the Department of Public Health
23under the Nursing Home Care Act as Intermediate Care for the
24Developmentally Disabled facilities or Long Term Care for Under
25Age 22 facilities, the rates taking effect on July 1, 1998
26shall include an increase of 3%. For facilities licensed by the

 

 

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1Department of Public Health under the Nursing Home Care Act as
2Skilled Nursing facilities or Intermediate Care facilities,
3the rates taking effect on July 1, 1998 shall include an
4increase of 3% plus $1.10 per resident-day, as defined by the
5Department. For facilities licensed by the Department of Public
6Health under the Nursing Home Care Act as Intermediate Care
7Facilities for the Developmentally Disabled or Long Term Care
8for Under Age 22 facilities, the rates taking effect on January
91, 2006 shall include an increase of 3%. For facilities
10licensed by the Department of Public Health under the Nursing
11Home Care Act as Intermediate Care Facilities for the
12Developmentally Disabled or Long Term Care for Under Age 22
13facilities, the rates taking effect on January 1, 2009 shall
14include an increase sufficient to provide a $0.50 per hour wage
15increase for non-executive staff.
16    For facilities licensed by the Department of Public Health
17under the Nursing Home Care Act as Intermediate Care for the
18Developmentally Disabled facilities or Long Term Care for Under
19Age 22 facilities, the rates taking effect on July 1, 1999
20shall include an increase of 1.6% plus $3.00 per resident-day,
21as defined by the Department. For facilities licensed by the
22Department of Public Health under the Nursing Home Care Act as
23Skilled Nursing facilities or Intermediate Care facilities,
24the rates taking effect on July 1, 1999 shall include an
25increase of 1.6% and, for services provided on or after October
261, 1999, shall be increased by $4.00 per resident-day, as

 

 

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1defined by the Department.
2    For facilities licensed by the Department of Public Health
3under the Nursing Home Care Act as Intermediate Care for the
4Developmentally Disabled facilities or Long Term Care for Under
5Age 22 facilities, the rates taking effect on July 1, 2000
6shall include an increase of 2.5% per resident-day, as defined
7by the Department. For facilities licensed by the Department of
8Public Health under the Nursing Home Care Act as Skilled
9Nursing facilities or Intermediate Care facilities, the rates
10taking effect on July 1, 2000 shall include an increase of 2.5%
11per resident-day, as defined by the Department.
12    For facilities licensed by the Department of Public Health
13under the Nursing Home Care Act as skilled nursing facilities
14or intermediate care facilities, a new payment methodology must
15be implemented for the nursing component of the rate effective
16July 1, 2003. The Department of Public Aid (now Healthcare and
17Family Services) shall develop the new payment methodology
18using the Minimum Data Set (MDS) as the instrument to collect
19information concerning nursing home resident condition
20necessary to compute the rate. The Department shall develop the
21new payment methodology to meet the unique needs of Illinois
22nursing home residents while remaining subject to the
23appropriations provided by the General Assembly. A transition
24period from the payment methodology in effect on June 30, 2003
25to the payment methodology in effect on July 1, 2003 shall be
26provided for a period not exceeding 3 years and 184 days after

 

 

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1implementation of the new payment methodology as follows:
2        (A) For a facility that would receive a lower nursing
3    component rate per patient day under the new system than
4    the facility received effective on the date immediately
5    preceding the date that the Department implements the new
6    payment methodology, the nursing component rate per
7    patient day for the facility shall be held at the level in
8    effect on the date immediately preceding the date that the
9    Department implements the new payment methodology until a
10    higher nursing component rate of reimbursement is achieved
11    by that facility.
12        (B) For a facility that would receive a higher nursing
13    component rate per patient day under the payment
14    methodology in effect on July 1, 2003 than the facility
15    received effective on the date immediately preceding the
16    date that the Department implements the new payment
17    methodology, the nursing component rate per patient day for
18    the facility shall be adjusted.
19        (C) Notwithstanding paragraphs (A) and (B), the
20    nursing component rate per patient day for the facility
21    shall be adjusted subject to appropriations provided by the
22    General Assembly.
23    For facilities licensed by the Department of Public Health
24under the Nursing Home Care Act as Intermediate Care for the
25Developmentally Disabled facilities or Long Term Care for Under
26Age 22 facilities, the rates taking effect on March 1, 2001

 

 

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1shall include a statewide increase of 7.85%, as defined by the
2Department.
3    Notwithstanding any other provision of this Section, for
4facilities licensed by the Department of Public Health under
5the Nursing Home Care Act as skilled nursing facilities or
6intermediate care facilities, except facilities participating
7in the Department's demonstration program pursuant to the
8provisions of Title 77, Part 300, Subpart T of the Illinois
9Administrative Code, the numerator of the ratio used by the
10Department of Healthcare and Family Services to compute the
11rate payable under this Section using the Minimum Data Set
12(MDS) methodology shall incorporate the following annual
13amounts as the additional funds appropriated to the Department
14specifically to pay for rates based on the MDS nursing
15component methodology in excess of the funding in effect on
16December 31, 2006:
17        (i) For rates taking effect January 1, 2007,
18    $60,000,000.
19        (ii) For rates taking effect January 1, 2008,
20    $110,000,000.
21        (iii) For rates taking effect January 1, 2009,
22    $194,000,000.
23        (iv) For rates taking effect April 1, 2011, or the
24    first day of the month that begins at least 45 days after
25    the effective date of this amendatory Act of the 96th
26    General Assembly, $416,500,000 or an amount as may be

 

 

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1    necessary to complete the transition to the MDS methodology
2    for the nursing component of the rate. Increased payments
3    under this item (iv) are not due and payable, however,
4    until (i) the methodologies described in this paragraph are
5    approved by the federal government in an appropriate State
6    Plan amendment and (ii) the assessment imposed by Section
7    5B-2 of this Code is determined to be a permissible tax
8    under Title XIX of the Social Security Act.
9    Notwithstanding any other provision of this Section, for
10facilities licensed by the Department of Public Health under
11the Nursing Home Care Act as skilled nursing facilities or
12intermediate care facilities, the support component of the
13rates taking effect on January 1, 2008 shall be computed using
14the most recent cost reports on file with the Department of
15Healthcare and Family Services no later than April 1, 2005,
16updated for inflation to January 1, 2006.
17    For facilities licensed by the Department of Public Health
18under the Nursing Home Care Act as Intermediate Care for the
19Developmentally Disabled facilities or Long Term Care for Under
20Age 22 facilities, the rates taking effect on April 1, 2002
21shall include a statewide increase of 2.0%, as defined by the
22Department. This increase terminates on July 1, 2002; beginning
23July 1, 2002 these rates are reduced to the level of the rates
24in effect on March 31, 2002, as defined by the Department.
25    For facilities licensed by the Department of Public Health
26under the Nursing Home Care Act as skilled nursing facilities

 

 

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1or intermediate care facilities, the rates taking effect on
2July 1, 2001 shall be computed using the most recent cost
3reports on file with the Department of Public Aid no later than
4April 1, 2000, updated for inflation to January 1, 2001. For
5rates effective July 1, 2001 only, rates shall be the greater
6of the rate computed for July 1, 2001 or the rate effective on
7June 30, 2001.
8    Notwithstanding any other provision of this Section, for
9facilities licensed by the Department of Public Health under
10the Nursing Home Care Act as skilled nursing facilities or
11intermediate care facilities, the Illinois Department shall
12determine by rule the rates taking effect on July 1, 2002,
13which shall be 5.9% less than the rates in effect on June 30,
142002.
15    Notwithstanding any other provision of this Section, for
16facilities licensed by the Department of Public Health under
17the Nursing Home Care Act as skilled nursing facilities or
18intermediate care facilities, if the payment methodologies
19required under Section 5A-12 and the waiver granted under 42
20CFR 433.68 are approved by the United States Centers for
21Medicare and Medicaid Services, the rates taking effect on July
221, 2004 shall be 3.0% greater than the rates in effect on June
2330, 2004. These rates shall take effect only upon approval and
24implementation of the payment methodologies required under
25Section 5A-12.
26    Notwithstanding any other provisions of this Section, for

 

 

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1facilities licensed by the Department of Public Health under
2the Nursing Home Care Act as skilled nursing facilities or
3intermediate care facilities, the rates taking effect on
4January 1, 2005 shall be 3% more than the rates in effect on
5December 31, 2004.
6    Notwithstanding any other provision of this Section, for
7facilities licensed by the Department of Public Health under
8the Nursing Home Care Act as skilled nursing facilities or
9intermediate care facilities, effective January 1, 2009, the
10per diem support component of the rates effective on January 1,
112008, computed using the most recent cost reports on file with
12the Department of Healthcare and Family Services no later than
13April 1, 2005, updated for inflation to January 1, 2006, shall
14be increased to the amount that would have been derived using
15standard Department of Healthcare and Family Services methods,
16procedures, and inflators.
17    Notwithstanding any other provisions of this Section, for
18facilities licensed by the Department of Public Health under
19the Nursing Home Care Act as intermediate care facilities that
20are federally defined as Institutions for Mental Disease, or
21facilities licensed by the Department of Public Health under
22the Specialized Mental Health Rehabilitation Act, a
23socio-development component rate equal to 6.6% of the
24facility's nursing component rate as of January 1, 2006 shall
25be established and paid effective July 1, 2006. The
26socio-development component of the rate shall be increased by a

 

 

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1factor of 2.53 on the first day of the month that begins at
2least 45 days after January 11, 2008 (the effective date of
3Public Act 95-707). As of August 1, 2008, the socio-development
4component rate shall be equal to 6.6% of the facility's nursing
5component rate as of January 1, 2006, multiplied by a factor of
63.53. For services provided on or after April 1, 2011, or the
7first day of the month that begins at least 45 days after the
8effective date of this amendatory Act of the 96th General
9Assembly, whichever is later, the Illinois Department may by
10rule adjust these socio-development component rates, and may
11use different adjustment methodologies for those facilities
12participating, and those not participating, in the Illinois
13Department's demonstration program pursuant to the provisions
14of Title 77, Part 300, Subpart T of the Illinois Administrative
15Code, but in no case may such rates be diminished below those
16in effect on August 1, 2008.
17    For facilities licensed by the Department of Public Health
18under the Nursing Home Care Act as Intermediate Care for the
19Developmentally Disabled facilities or as long-term care
20facilities for residents under 22 years of age, the rates
21taking effect on July 1, 2003 shall include a statewide
22increase of 4%, as defined by the Department.
23    For facilities licensed by the Department of Public Health
24under the Nursing Home Care Act as Intermediate Care for the
25Developmentally Disabled facilities or Long Term Care for Under
26Age 22 facilities, the rates taking effect on the first day of

 

 

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1the month that begins at least 45 days after the effective date
2of this amendatory Act of the 95th General Assembly shall
3include a statewide increase of 2.5%, as defined by the
4Department.
5    Notwithstanding any other provision of this Section, for
6facilities licensed by the Department of Public Health under
7the Nursing Home Care Act as skilled nursing facilities or
8intermediate care facilities, effective January 1, 2005,
9facility rates shall be increased by the difference between (i)
10a facility's per diem property, liability, and malpractice
11insurance costs as reported in the cost report filed with the
12Department of Public Aid and used to establish rates effective
13July 1, 2001 and (ii) those same costs as reported in the
14facility's 2002 cost report. These costs shall be passed
15through to the facility without caps or limitations, except for
16adjustments required under normal auditing procedures.
17    Rates established effective each July 1 shall govern
18payment for services rendered throughout that fiscal year,
19except that rates established on July 1, 1996 shall be
20increased by 6.8% for services provided on or after January 1,
211997. Such rates will be based upon the rates calculated for
22the year beginning July 1, 1990, and for subsequent years
23thereafter until June 30, 2001 shall be based on the facility
24cost reports for the facility fiscal year ending at any point
25in time during the previous calendar year, updated to the
26midpoint of the rate year. The cost report shall be on file

 

 

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1with the Department no later than April 1 of the current rate
2year. Should the cost report not be on file by April 1, the
3Department shall base the rate on the latest cost report filed
4by each skilled care facility and intermediate care facility,
5updated to the midpoint of the current rate year. In
6determining rates for services rendered on and after July 1,
71985, fixed time shall not be computed at less than zero. The
8Department shall not make any alterations of regulations which
9would reduce any component of the Medicaid rate to a level
10below what that component would have been utilizing in the rate
11effective on July 1, 1984.
12    (2) Shall take into account the actual costs incurred by
13facilities in providing services for recipients of skilled
14nursing and intermediate care services under the medical
15assistance program.
16    (3) Shall take into account the medical and psycho-social
17characteristics and needs of the patients.
18    (4) Shall take into account the actual costs incurred by
19facilities in meeting licensing and certification standards
20imposed and prescribed by the State of Illinois, any of its
21political subdivisions or municipalities and by the U.S.
22Department of Health and Human Services pursuant to Title XIX
23of the Social Security Act.
24    The Department of Healthcare and Family Services shall
25develop precise standards for payments to reimburse nursing
26facilities for any utilization of appropriate rehabilitative

 

 

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1personnel for the provision of rehabilitative services which is
2authorized by federal regulations, including reimbursement for
3services provided by qualified therapists or qualified
4assistants, and which is in accordance with accepted
5professional practices. Reimbursement also may be made for
6utilization of other supportive personnel under appropriate
7supervision.
8    The Department shall develop enhanced payments to offset
9the additional costs incurred by a facility serving exceptional
10need residents and shall allocate at least $8,000,000 of the
11funds collected from the assessment established by Section 5B-2
12of this Code for such payments. For the purpose of this
13Section, "exceptional needs" means, but need not be limited to,
14ventilator care, tracheotomy care, bariatric care, complex
15wound care, and traumatic brain injury care. The enhanced
16payments for exceptional need residents under this paragraph
17are not due and payable, however, until (i) the methodologies
18described in this paragraph are approved by the federal
19government in an appropriate State Plan amendment and (ii) the
20assessment imposed by Section 5B-2 of this Code is determined
21to be a permissible tax under Title XIX of the Social Security
22Act.
23    Beginning April 1, 2013, January 1, 2014 the methodologies
24for reimbursement of nursing facility services as provided
25under this Section 5-5.4 shall no longer be applicable for
26services provided on or after April 1, 2013 January 1, 2014.

 

 

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1    No payment increase under this Section for the MDS
2methodology, exceptional care residents, or the
3socio-development component rate established by Public Act
496-1530 of the 96th General Assembly and funded by the
5assessment imposed under Section 5B-2 of this Code shall be due
6and payable until after the Department notifies the long-term
7care providers, in writing, that the payment methodologies to
8long-term care providers required under this Section have been
9approved by the Centers for Medicare and Medicaid Services of
10the U.S. Department of Health and Human Services and the
11waivers under 42 CFR 433.68 for the assessment imposed by this
12Section, if necessary, have been granted by the Centers for
13Medicare and Medicaid Services of the U.S. Department of Health
14and Human Services. Upon notification to the Department of
15approval of the payment methodologies required under this
16Section and the waivers granted under 42 CFR 433.68, all
17increased payments otherwise due under this Section prior to
18the date of notification shall be due and payable within 90
19days of the date federal approval is received.
20    On and after July 1, 2012, the Department shall reduce any
21rate of reimbursement for services or other payments or alter
22any methodologies authorized by this Code to reduce any rate of
23reimbursement for services or other payments in accordance with
24Section 5-5e.
25(Source: P.A. 96-45, eff. 7-15-09; 96-339, eff. 7-1-10; 96-959,
26eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1530, eff. 2-16-11;

 

 

SB1476- 21 -LRB098 07061 DRJ 37120 b

197-10, eff. 6-14-11; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12;
297-584, eff. 8-26-11; 97-689, eff. 6-14-12; 97-813, eff.
37-13-12.)
 
4    Section 99. Effective date. This Act takes effect April 1,
52013.