Public Act 93-0649

HB2657 Enrolled                      LRB093 04135 RCE 04178 b

    AN ACT in relation to budget implementation.

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

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

    (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
    Sec. 5-5.4.  Standards of Payment - Department of  Public
Aid.  The Department of Public Aid shall develop standards of
payment of skilled nursing and intermediate care services  in
facilities providing such services under this Article which:
    (1)  Provide   for  the  determination  of  a  facility's
payment for skilled nursing and intermediate care services on
a prospective basis. The amount of the payment rate  for  all
nursing  facilities  certified  by  the  Department of Public
Health under the Nursing Home Care Act as  Intermediate  Care
for  the  Developmentally Disabled facilities, Long Term Care
for Under Age 22 facilities, Skilled Nursing  facilities,  or
Intermediate  Care  facilities  under  the medical assistance
program shall be prospectively established  annually  on  the
basis   of   historical,   financial,  and  statistical  data
reflecting actual costs from  prior  years,  which  shall  be
applied  to  the current rate year and updated for inflation,
except that the capital cost element  for  newly  constructed
facilities  shall  be  based  upon  projected  budgets.   The
annually established payment rate shall take effect on July 1
in 1984 and subsequent years.  No rate increase and no update
for  inflation shall be provided on or after July 1, 1994 and
before July 1, 2004, unless specifically provided for in this
Section.
    For facilities  licensed  by  the  Department  of  Public
Health  under  the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on  July
1,  1998  shall  include  an  increase of 3%.  For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Skilled Nursing facilities  or  Intermediate
Care  facilities,  the  rates  taking  effect on July 1, 1998
shall include an increase of 3% plus $1.10 per  resident-day,
as defined by the Department.
    For  facilities  licensed  by  the  Department  of Public
Health under the Nursing Home Care Act as  Intermediate  Care
for the Developmentally Disabled facilities or Long Term Care
for  Under Age 22 facilities, the rates taking effect on July
1, 1999 shall include an increase  of  1.6%  plus  $3.00  per
resident-day,  as  defined by the Department.  For facilities
licensed by the Department of Public Health under the Nursing
Home Care Act as Skilled Nursing facilities  or  Intermediate
Care  facilities,  the  rates  taking  effect on July 1, 1999
shall include an increase of 1.6% and, for services  provided
on  or after October 1, 1999, shall be increased by $4.00 per
resident-day, as defined by the Department.
    For facilities  licensed  by  the  Department  of  Public
Health  under  the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on  July
1,  2000  shall include an increase of 2.5% per resident-day,
as defined by the Department.  For facilities licensed by the
Department of Public Health under the Nursing Home  Care  Act
as   Skilled   Nursing   facilities   or   Intermediate  Care
facilities, the rates taking effect on  July  1,  2000  shall
include  an  increase of 2.5% per resident-day, as defined by
the Department.
    For facilities  licensed  by  the  Department  of  Public
Health  under  the  Nursing  Home Care Act as skilled nursing
facilities or intermediate care  facilities,  a  new  payment
methodology  must be implemented for the nursing component of
the rate effective July 1, 2003. The Department of Public Aid
shall develop the new payment methodology using  the  Minimum
Data  Set  (MDS)  as  the  instrument  to collect information
concerning  nursing  home  resident  condition  necessary  to
compute the rate. The Department of Public Aid shall  develop
the  new  payment  methodology  to  meet  the unique needs of
Illinois nursing home residents while  remaining  subject  to
the  appropriations  provided  by  the  General  Assembly.  A
transition  period  from the payment methodology in effect on
June 30, 2003 to the payment methodology in effect on July 1,
2003 shall be provided for a period  not  exceeding  2  years
after  implementation  of  the  new  payment  methodology  as
follows:
         (A)  For  a  facility  that  would  receive  a lower
    nursing component rate per  patient  day  under  the  new
    system  than  the facility received effective on the date
    immediately  preceding  the  date  that  the   Department
    implements  the  new  payment  methodology,  the  nursing
    component  rate per patient day for the facility shall be
    held at the level  in  effect  on  the  date  immediately
    preceding the date that the Department implements the new
    payment methodology until a higher nursing component rate
    of reimbursement is achieved by that facility.
         (B)  For  a  facility  that  would  receive a higher
    nursing component rate per patient day under the  payment
    methodology  in  effect on July 1, 2003 than the facility
    received effective on the date immediately preceding  the
    date  that  the  Department  implements  the  new payment
    methodology, the nursing component rate per  patient  day
    for the facility shall be adjusted.
         (C)  Notwithstanding  paragraphs  (A)  and  (B), the
    nursing component rate per patient day for  the  facility
    shall  be  adjusted subject to appropriations provided by
    the General Assembly.
    For facilities  licensed  by  the  Department  of  Public
Health  under  the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on March
1, 2001 shall include  a  statewide  increase  of  7.85%,  as
defined by the Department.
    For  facilities  licensed  by  the  Department  of Public
Health under the Nursing Home Care Act as  Intermediate  Care
for the Developmentally Disabled facilities or Long Term Care
for Under Age 22 facilities, the rates taking effect on April
1,  2002  shall  include  a  statewide  increase  of 2.0%, as
defined by the Department. This increase terminates  on  July
1,  2002;  beginning  July 1, 2002 these rates are reduced to
the level of the rates  in  effect  on  March  31,  2002,  as
defined by the Department.
    For  facilities  licensed  by  the  Department  of Public
Health under the Nursing Home Care  Act  as  skilled  nursing
facilities  or intermediate care facilities, the rates taking
effect on July 1, 2001  shall  be  computed  using  the  most
recent cost reports on file with the Department of Public Aid
no later than April 1, 2000, updated for inflation to January
1,  2001.  For rates effective July 1, 2001 only, rates shall
be the greater of the rate computed for July 1, 2001  or  the
rate effective on June 30, 2001.
    Notwithstanding  any other provision of this Section, for
facilities licensed by the Department of Public Health  under
the  Nursing  Home  Care Act as skilled nursing facilities or
intermediate care facilities, the Illinois  Department  shall
determine  by  rule  the rates taking effect on July 1, 2002,
which shall be 5.9% less than the rates in effect on June 30,
2002.
    For facilities  licensed  by  the  Department  of  Public
Health  under  the Nursing Home Care Act as Intermediate Care
for the Developmentally Disabled facilities or  as  long-term
care  facilities  for  residents  under  22 years of age, the
rates taking effect on July 1, 2003 shall include a statewide
increase of 4%, as defined by the Department.
    Rates established effective  each  July  1  shall  govern
payment  for  services  rendered throughout that fiscal year,
except that rates  established  on  July  1,  1996  shall  be
increased  by  6.8% for services provided on or after January
1, 1997.  Such rates will be based upon the rates  calculated
for the year beginning July 1, 1990, and for subsequent years
thereafter until June 30, 2001 shall be based on the facility
cost reports for the facility fiscal year ending at any point
in  time  during  the  previous calendar year, updated to the
midpoint of the rate year.  The cost report shall be on  file
with the Department no later than April 1 of the current rate
year.   Should the cost report not be on file by April 1, the
Department shall base the rate  on  the  latest  cost  report
filed  by  each  skilled  care facility and intermediate care
facility, updated to the midpoint of the current  rate  year.
In  determining rates for services rendered on and after July
1, 1985, fixed time shall not be computed at less than  zero.
The  Department shall not make any alterations of regulations
which would reduce any component of the Medicaid  rate  to  a
level  below what that component would have been utilizing in
the rate effective on July 1, 1984.
    (2)  Shall take into account the actual costs incurred by
facilities in providing services for  recipients  of  skilled
nursing  and  intermediate  care  services  under the medical
assistance program.
    (3)  Shall   take   into   account   the   medical    and
psycho-social characteristics and needs of the patients.
    (4)  Shall take into account the actual costs incurred by
facilities  in  meeting licensing and certification standards
imposed and prescribed by the State of Illinois, any  of  its
political  subdivisions  or  municipalities  and  by the U.S.
Department of Health and Human Services pursuant to Title XIX
of the Social Security Act.
    The  Department  of  Public  Aid  shall  develop  precise
standards for payments to reimburse  nursing  facilities  for
any  utilization  of appropriate rehabilitative personnel for
the provision of rehabilitative services which is  authorized
by  federal regulations, including reimbursement for services
provided by qualified therapists or qualified assistants, and
which is in accordance with accepted professional  practices.
Reimbursement  also  may  be  made  for  utilization of other
supportive personnel under appropriate supervision.
(Source: P.A.  92-10,  eff.  6-11-01;  92-31,  eff.  6-28-01;
92-597,  eff.  6-28-02;  92-651,  eff.  7-11-02; 92-848, eff.
1-1-03; 93-20, eff. 6-20-03.)

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

Effective Date: 01/08/04