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Public Act 102-1035
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| HB0246 Enrolled | LRB102 10452 SPS 15780 b |
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 1. The Illinois Administrative Procedure Act is |
amended by adding Section 5-45.21 as follows:
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(5 ILCS 100/5-45.21 new) |
Sec. 5-45.21. Emergency rulemaking; Department of |
Healthcare and Family Services. To provide for the expeditious |
and timely implementation of the changes made to Articles 5 |
and 5B of the Illinois Public Aid Code by this amendatory Act |
of the 102nd General Assembly, emergency rules implementing |
the changes made to Articles 5 and 5B of the Illinois Public |
Aid Code by this amendatory Act of the 102nd General Assembly |
may be adopted in accordance with Section 5-45 by the |
Department of Healthcare and Family Services. The adoption of |
emergency rules authorized by Section 5-45 and this Section is |
deemed to be necessary for the public interest, safety, and |
welfare. |
This Section is repealed on September 30, 2022.
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Section 5. The Illinois Public Aid Code is amended by |
changing Sections 5-5.2, 5-5.8, 5B-2, 5B-4, 5B-5, 5B-8, and |
5E-10 and by adding Section 5E-20 as follows:
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(305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
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Sec. 5-5.2. Payment.
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(a) All nursing facilities that are grouped pursuant to |
Section
5-5.1 of this Act shall receive the same rate of |
payment for similar
services.
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(b) It shall be a matter of State policy that the Illinois |
Department
shall utilize a uniform billing cycle throughout |
the State for the
long-term care providers.
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(c) (Blank). Notwithstanding any other provisions of this |
Code, the methodologies for reimbursement of nursing services |
as provided under this Article 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 January 1, 2014. |
(c-1) Notwithstanding any other provisions of this Code, |
the methodologies for reimbursement of nursing services as |
provided under this Article shall no longer be applicable for |
bills payable for nursing services rendered on or after a new |
reimbursement system based on the Patient Driven Payment Model |
(PDPM) has been fully operationalized, which shall take effect |
for services provided on or after the implementation of the |
PDPM reimbursement system begins. For the purposes of this |
amendatory Act of the 102nd General Assembly, the |
implementation date of the PDPM reimbursement system and all |
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related provisions shall be July 1, 2022 if the following |
conditions are met: (i) the Centers for Medicare and Medicaid |
Services has approved corresponding changes in the |
reimbursement system and bed assessment; and (ii) the |
Department has filed rules to implement these changes no later |
than June 1, 2022. Failure of the Department to file rules to |
implement the changes provided in this amendatory Act of the |
102nd General Assembly no later than June 1, 2022 shall result |
in the implementation date being delayed to October 1, 2022. |
(d) The new nursing services reimbursement methodology |
utilizing the Patient Driven Payment Model RUG-IV 48 grouper |
model, which shall be referred to as the PDPM RUGs |
reimbursement system, taking effect July 1, 2022, upon federal |
approval by the Centers for Medicare and Medicaid Services |
January 1, 2014, shall be based on the following: |
(1) The methodology shall be resident-centered |
resident-driven, facility-specific, cost-based, and based |
on guidance from the Centers for Medicare and Medicaid |
Services and cost-based. |
(2) Costs shall be annually rebased and case mix index |
quarterly updated. The nursing services methodology will |
be assigned to the Medicaid enrolled residents on record |
as of 30 days prior to the beginning of the rate period in |
the Department's Medicaid Management Information System |
(MMIS) as present on the last day of the second quarter |
preceding the rate period based upon the Assessment |
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Reference Date of the Minimum Data Set (MDS). |
(3) Regional wage adjustors based on the Health |
Service Areas (HSA) groupings and adjusters in effect on |
April 30, 2012 shall be included, except no adjuster shall |
be lower than 1.06 1.0. |
(4) PDPM nursing case mix indices in effect on March |
1, 2022 Case mix index shall be assigned to each resident |
class at no less than 0.7858 of based on the Centers for |
Medicare and Medicaid Services PDPM unadjusted case mix |
values, in effect on March 1, 2022, staff time measurement |
study in effect on July 1, 2013, utilizing an index |
maximization approach. |
(5) The pool of funds available for distribution by |
case mix and the base facility rate shall be determined |
using the formula contained in subsection (d-1). |
(6) The Department shall establish a variable per diem |
staffing add-on in accordance with the most recent |
available federal staffing report, currently the Payroll |
Based Journal, for the same period of time, and if |
applicable adjusted for acuity using the same quarter's |
MDS. The Department shall rely on Payroll Based Journals |
provided to the Department of Public Health to make a |
determination of non-submission. If the Department is |
notified by a facility of missing or inaccurate Payroll |
Based Journal data or an incorrect calculation of |
staffing, the Department must make a correction as soon as |
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the error is verified for the applicable quarter. |
Facilities with at least 70% of the staffing indicated |
by the STRIVE study shall be paid a per diem add-on of $9, |
increasing by equivalent steps for each whole percentage |
point until the facilities reach a per diem of $14.88. |
Facilities with at least 80% of the staffing indicated by |
the STRIVE study shall be paid a per diem add-on of $14.88, |
increasing by equivalent steps for each whole percentage |
point until the facilities reach a per diem add-on of |
$23.80. Facilities with at least 92% of the staffing |
indicated by the STRIVE study shall be paid a per diem |
add-on of $23.80, increasing by equivalent steps for each |
whole percentage point until the facilities reach a per |
diem add-on of $29.75. Facilities with at least 100% of |
the staffing indicated by the STRIVE study shall be paid a |
per diem add-on of $29.75, increasing by equivalent steps |
for each whole percentage point until the facilities reach |
a per diem add-on of $35.70. Facilities with at least 110% |
of the staffing indicated by the STRIVE study shall be |
paid a per diem add-on of $35.70, increasing by equivalent |
steps for each whole percentage point until the facilities |
reach a per diem add-on of $38.68. Facilities with at |
least 125% or higher of the staffing indicated by the |
STRIVE study shall be paid a per diem add-on of $38.68. |
Beginning April 1, 2023, no nursing facility's variable |
staffing per diem add-on shall be reduced by more than 5% |
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in 2 consecutive quarters. For the quarters beginning July |
1, 2022 and October 1, 2022, no facility's variable per |
diem staffing add-on shall be calculated at a rate lower |
than 85% of the staffing indicated by the STRIVE study. No |
facility below 70% of the staffing indicated by the STRIVE |
study shall receive a variable per diem staffing add-on |
after December 31, 2022. |
(7) For dates of services beginning July 1, 2022, the |
PDPM nursing component per diem for each nursing facility |
shall be the product of the facility's (i) statewide PDPM |
nursing base per diem rate, $92.25, adjusted for the |
facility average PDPM case mix index calculated quarterly |
and (ii) the regional wage adjuster, and then add the |
Medicaid access adjustment as defined in (e-3) of this |
Section. Transition rates for services provided between |
July 1, 2022 and October 1, 2023 shall be the greater of |
the PDPM nursing component per diem or: |
(A) for the quarter beginning July 1, 2022, the |
RUG-IV nursing component per diem; |
(B) for the quarter beginning October 1, 2022, the |
sum of the RUG-IV nursing component per diem |
multiplied by 0.80 and the PDPM nursing component per |
diem multiplied by 0.20; |
(C) for the quarter beginning January 1, 2023, the |
sum of the RUG-IV nursing component per diem |
multiplied by 0.60 and the PDPM nursing component per |
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diem multiplied by 0.40; |
(D) for the quarter beginning April 1, 2023, the |
sum of the RUG-IV nursing component per diem |
multiplied by 0.40 and the PDPM nursing component per |
diem multiplied by 0.60; |
(E) for the quarter beginning July 1, 2023, the |
sum of the RUG-IV nursing component per diem |
multiplied by 0.20 and the PDPM nursing component per |
diem multiplied by 0.80; or |
(F) for the quarter beginning October 1, 2023 and |
each subsequent quarter, the transition rate shall end |
and a nursing facility shall be paid 100% of the PDPM |
nursing component per diem. |
(d-1) Calculation of base year Statewide RUG-IV nursing |
base per diem rate. |
(1) Base rate spending pool shall be: |
(A) The base year resident days which are calculated |
by multiplying the number of Medicaid residents in each |
nursing home as indicated in the MDS data defined in |
paragraph (4) by 365. |
(B) Each facility's nursing component per diem in |
effect on July 1, 2012 shall be multiplied by subsection |
(A). |
(C) Thirteen million is added to the product of |
subparagraph (A) and subparagraph (B) to adjust for |
the exclusion of nursing homes defined in paragraph |
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(5). |
(2) For each nursing home with Medicaid residents as |
indicated by the MDS data defined in paragraph (4), |
weighted days adjusted for case mix and regional wage |
adjustment shall be calculated. For each home this |
calculation is the product of: |
(A) Base year resident days as calculated in |
subparagraph (A) of paragraph (1). |
(B) The nursing home's regional wage adjustor |
based on the Health Service Areas (HSA) groupings and |
adjustors in effect on April 30, 2012. |
(C) Facility weighted case mix which is the number |
of Medicaid residents as indicated by the MDS data |
defined in paragraph (4) multiplied by the associated |
case weight for the RUG-IV 48 grouper model using |
standard RUG-IV procedures for index maximization. |
(D) The sum of the products calculated for each |
nursing home in subparagraphs (A) through (C) above |
shall be the base year case mix, rate adjusted |
weighted days. |
(3) The Statewide RUG-IV nursing base per diem rate: |
(A) on January 1, 2014 shall be the quotient of the |
paragraph (1) divided by the sum calculated under |
subparagraph (D) of paragraph (2); and |
(B) on and after July 1, 2014 and until July 1, |
2022, shall be the amount calculated under |
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subparagraph (A) of this paragraph (3) plus $1.76; and |
. |
(C) beginning July 1, 2022 and thereafter, $7 |
shall be added to the amount calculated under |
subparagraph (B) of this paragraph (3) of this |
Section. |
(4) Minimum Data Set (MDS) comprehensive assessments |
for Medicaid residents on the last day of the quarter used |
to establish the base rate. |
(5) Nursing facilities designated as of July 1, 2012 |
by the Department as "Institutions for Mental Disease" |
shall be excluded from all calculations under this |
subsection. The data from these facilities shall not be |
used in the computations described in paragraphs (1) |
through (4) above to establish the base rate. |
(e) Beginning July 1, 2014, the Department shall allocate |
funding in the amount up to $10,000,000 for per diem add-ons to |
the RUGS methodology for dates of service on and after July 1, |
2014: |
(1) $0.63 for each resident who scores in I4200 |
Alzheimer's Disease or I4800 non-Alzheimer's Dementia. |
(2) $2.67 for each resident who scores either a "1" or |
"2" in any items S1200A through S1200I and also scores in |
RUG groups PA1, PA2, BA1, or BA2. |
(e-1) (Blank). |
(e-2) For dates of services beginning January 1, 2014 and |
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ending September 30, 2023, the RUG-IV nursing component per |
diem for a nursing home shall be the product of the statewide |
RUG-IV nursing base per diem rate, the facility average case |
mix index, and the regional wage adjustor. Transition rates |
for services provided between January 1, 2014 and December 31, |
2014 shall be as follows: |
(1) The transition RUG-IV per diem nursing rate for |
nursing homes whose rate calculated in this subsection |
(e-2) is greater than the nursing component rate in effect |
July 1, 2012 shall be paid the sum of: |
(A) The nursing component rate in effect July 1, |
2012; plus |
(B) The difference of the RUG-IV nursing component |
per diem calculated for the current quarter minus the |
nursing component rate in effect July 1, 2012 |
multiplied by 0.88. |
(2) The transition RUG-IV per diem nursing rate for |
nursing homes whose rate calculated in this subsection |
(e-2) is less than the nursing component rate in effect |
July 1, 2012 shall be paid the sum of: |
(A) The nursing component rate in effect July 1, |
2012; plus |
(B) The difference of the RUG-IV nursing component |
per diem calculated for the current quarter minus the |
nursing component rate in effect July 1, 2012 |
multiplied by 0.13. |
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(e-3) A Medicaid Access Adjustment of $4 adjusted for the |
facility average PDPM case mix index calculated quarterly |
shall be added to the statewide PDPM nursing per diem for all |
facilities with annual Medicaid bed days of at least 70% of all |
occupied bed days adjusted quarterly. For each new calendar |
year and for the 6-month period beginning July 1, 2022, the |
percentage of a facility's occupied bed days comprised of |
Medicaid bed days shall be determined by the Department |
quarterly. This subsection shall be inoperative on and after |
January 1, 2028. |
(f) (Blank). Notwithstanding any other provision of this |
Code, on and after July 1, 2012, reimbursement rates |
associated with the nursing or support components of the |
current nursing facility rate methodology shall not increase |
beyond the level effective May 1, 2011 until a new |
reimbursement system based on the RUGs IV 48 grouper model has |
been fully operationalized. |
(g) Notwithstanding any other provision of this Code, on |
and after July 1, 2012, for facilities not designated by the |
Department of Healthcare and Family Services as "Institutions |
for Mental Disease", rates effective May 1, 2011 shall be |
adjusted as follows: |
(1) (Blank); Individual nursing rates for residents |
classified in RUG IV groups PA1, PA2, BA1, and BA2 during |
the quarter ending March 31, 2012 shall be reduced by 10%; |
(2) (Blank); Individual nursing rates for residents |
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classified in all other RUG IV groups shall be reduced by |
1.0%; |
(3) Facility rates for the capital and support |
components shall be reduced by 1.7%. |
(h) Notwithstanding any other provision of this Code, on |
and after July 1, 2012, nursing facilities designated by the |
Department of Healthcare and Family Services as "Institutions |
for Mental Disease" and "Institutions for Mental Disease" that |
are facilities licensed under the Specialized Mental Health |
Rehabilitation Act of 2013 shall have the nursing, |
socio-developmental, capital, and support components of their |
reimbursement rate effective May 1, 2011 reduced in total by |
2.7%. |
(i) On and after July 1, 2014, the reimbursement rates for |
the support component of the nursing facility rate for |
facilities licensed under the Nursing Home Care Act as skilled |
or intermediate care facilities shall be the rate in effect on |
June 30, 2014 increased by 8.17%. |
(j) Notwithstanding any other provision of law, subject to |
federal approval, effective July 1, 2019, sufficient funds |
shall be allocated for changes to rates for facilities |
licensed under the Nursing Home Care Act as skilled nursing |
facilities or intermediate care facilities for dates of |
services on and after July 1, 2019: (i) to establish, through |
June 30, 2022 a per diem add-on to the direct care per diem |
rate not to exceed $70,000,000 annually in the aggregate |
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taking into account federal matching funds for the purpose of |
addressing the facility's unique staffing needs, adjusted |
quarterly and distributed by a weighted formula based on |
Medicaid bed days on the last day of the second quarter |
preceding the quarter for which the rate is being adjusted. |
Beginning July 1, 2022, the annual $70,000,000 described in |
the preceding sentence shall be dedicated to the variable per |
diem add-on for staffing under paragraph (6) of subsection |
(d); and (ii) in an amount not to exceed $170,000,000 annually |
in the aggregate taking into account federal matching funds to |
permit the support component of the nursing facility rate to |
be updated as follows: |
(1) 80%, or $136,000,000, of the funds shall be used |
to update each facility's rate in effect on June 30, 2019 |
using the most recent cost reports on file, which have had |
a limited review conducted by the Department of Healthcare |
and Family Services and will not hold up enacting the rate |
increase, with the Department of Healthcare and Family |
Services and taking into account subsection (i). |
(2) After completing the calculation in paragraph (1), |
any facility whose rate is less than the rate in effect on |
June 30, 2019 shall have its rate restored to the rate in |
effect on June 30, 2019 from the 20% of the funds set |
aside. |
(3) The remainder of the 20%, or $34,000,000, shall be |
used to increase each facility's rate by an equal |
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percentage. |
To implement item (i) in this subsection, facilities shall |
file quarterly reports documenting compliance with its |
annually approved staffing plan, which shall permit compliance |
with Section 3-202.05 of the Nursing Home Care Act. A facility |
that fails to meet the benchmarks and dates contained in the |
plan may have its add-on adjusted in the quarter following the |
quarterly review. Nothing in this Section shall limit the |
ability of the facility to appeal a ruling of non-compliance |
and a subsequent reduction to the add-on. Funds adjusted for |
noncompliance shall be maintained in the Long-Term Care |
Provider Fund and accounted for separately. At the end of each |
fiscal year, these funds shall be made available to facilities |
for special staffing projects. |
In order to provide for the expeditious and timely
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implementation of the provisions of Public Act 101-10, |
emergency rules to implement any provision of Public Act |
101-10 may be adopted in accordance with this subsection by |
the agency charged with administering that provision or
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initiative. The agency shall simultaneously file emergency |
rules and permanent rules to ensure that there is no |
interruption in administrative guidance. The 150-day |
limitation of the effective period of emergency rules does not |
apply to rules adopted under this
subsection, and the |
effective period may continue through
June 30, 2021. The |
24-month limitation on the adoption of
emergency rules does |
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not apply to rules adopted under this
subsection. The adoption |
of emergency rules authorized by this subsection is deemed to |
be necessary for the public interest, safety, and welfare. |
(k) During the first quarter of State Fiscal Year 2020, |
the Department of Healthcare of Family Services must convene a |
technical advisory group consisting of members of all trade |
associations representing Illinois skilled nursing providers |
to discuss changes necessary with federal implementation of |
Medicare's Patient-Driven Payment Model. Implementation of |
Medicare's Patient-Driven Payment Model shall, by September 1, |
2020, end the collection of the MDS data that is necessary to |
maintain the current RUG-IV Medicaid payment methodology. The |
technical advisory group must consider a revised reimbursement |
methodology that takes into account transparency, |
accountability, actual staffing as reported under the |
federally required Payroll Based Journal system, changes to |
the minimum wage, adequacy in coverage of the cost of care, and |
a quality component that rewards quality improvements. |
(l) The Department shall establish per diem add-on |
payments to improve the quality of care delivered by |
facilities, including: |
(1) Incentive payments determined by facility |
performance on specified quality measures in an initial |
amount of $70,000,000. Nothing in this subsection shall be |
construed to limit the quality of care payments in the |
aggregate statewide to $70,000,000, and, if quality of |
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care has improved across nursing facilities, the |
Department shall adjust those add-on payments accordingly. |
The quality payment methodology described in this |
subsection must be used for at least State Fiscal Year |
2023. Beginning with the quarter starting July 1, 2023, |
the Department may add, remove, or change quality metrics |
and make associated changes to the quality payment |
methodology as outlined in subparagraph (E). Facilities |
designated by the Centers for Medicare and Medicaid |
Services as a special focus facility or a hospital-based |
nursing home do not qualify for quality payments. |
(A) Each quality pool must be distributed by |
assigning a quality weighted score for each nursing |
home which is calculated by multiplying the nursing |
home's quality base period Medicaid days by the |
nursing home's star rating weight in that period. |
(B) Star rating weights are assigned based on the
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nursing home's star rating for the LTS quality star
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rating. As used in this subparagraph, "LTS quality
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star rating" means the long-term stay quality rating |
for
each nursing facility, as assigned by the Centers |
for
Medicare and Medicaid Services under the Five-Star
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Quality Rating System. The rating is a number ranging
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from 0 (lowest) to 5 (highest). |
(i) Zero-star or one-star rating has a weight |
of 0. |
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(ii) Two-star rating has a weight of 0.75. |
(iii) Three-star rating has a weight of 1.5. |
(iv) Four-star rating has a weight of 2.5. |
(v) Five-star rating has a weight of 3.5. |
(C) Each nursing home's quality weight score is |
divided by the sum of all quality weight scores for |
qualifying nursing homes to determine the proportion |
of the quality pool to be paid to the nursing home. |
(D) The quality pool is no less than $70,000,000 |
annually or $17,500,000 per quarter. The Department |
shall publish on its website the estimated payments |
and the associated weights for each facility 45 days |
prior to when the initial payments for the quarter are |
to be paid. The Department shall assign each facility |
the most recent and applicable quarter's STAR value |
unless the facility notifies the Department within 15 |
days of an issue and the facility provides reasonable |
evidence demonstrating its timely compliance with |
federal data submission requirements for the quarter |
of record. If such evidence cannot be provided to the |
Department, the STAR rating assigned to the facility |
shall be reduced by one from the prior quarter. |
(E) The Department shall review quality metrics |
used for payment of the quality pool and make |
recommendations for any associated changes to the |
methodology for distributing quality pool payments in |
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consultation with associations representing long-term |
care providers, consumer advocates, organizations |
representing workers of long-term care facilities, and |
payors. The Department may establish, by rule, changes |
to the methodology for distributing quality pool |
payments. |
(F) The Department shall disburse quality pool |
payments from the Long-Term Care Provider Fund on a |
monthly basis in amounts proportional to the total |
quality pool payment determined for the quarter. |
(G) The Department shall publish any changes in |
the methodology for distributing quality pool payments |
prior to the beginning of the measurement period or |
quality base period for any metric added to the |
distribution's methodology. |
(2) Payments based on CNA tenure, promotion, and CNA |
training for the purpose of increasing CNA compensation. |
It is the intent of this subsection that payments made in |
accordance with this paragraph be directly incorporated |
into increased compensation for CNAs. As used in this |
paragraph, "CNA" means a certified nursing assistant as |
that term is described in Section 3-206 of the Nursing |
Home Care Act, Section 3-206 of the ID/DD Community Care |
Act, and Section 3-206 of the MC/DD Act. The Department |
shall establish, by rule, payments to nursing facilities |
equal to Medicaid's share of the tenure wage increments |
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specified in this paragraph for all reported CNA employee |
hours compensated according to a posted schedule |
consisting of increments at least as large as those |
specified in this paragraph. The increments are as |
follows: an additional $1.50 per hour for CNAs with at |
least one and less than 2 years' experience plus another |
$1 per hour for each additional year of experience up to a |
maximum of $6.50 for CNAs with at least 6 years of |
experience. For purposes of this paragraph, Medicaid's |
share shall be the ratio determined by paid Medicaid bed |
days divided by total bed days for the applicable time |
period used in the calculation. In addition, and additive |
to any tenure increments paid as specified in this |
paragraph, the Department shall establish, by rule, |
payments supporting Medicaid's share of the |
promotion-based wage increments for CNA employee hours |
compensated for that promotion with at least a $1.50 |
hourly increase. Medicaid's share shall be established as |
it is for the tenure increments described in this |
paragraph. Qualifying promotions shall be defined by the |
Department in rules for an expected 10-15% subset of CNAs |
assigned intermediate, specialized, or added roles such as |
CNA trainers, CNA scheduling "captains", and CNA |
specialists for resident conditions like dementia or |
memory care or behavioral health. |
(m) The Department shall work with nursing facility |
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industry representatives to design policies and procedures to |
permit facilities to address the integrity of data from |
federal reporting sites used by the Department in setting |
facility rates. |
(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19; |
102-77, eff. 7-9-21; 102-558, eff. 8-20-21.)
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(305 ILCS 5/5-5.8) (from Ch. 23, par. 5-5.8)
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Sec. 5-5.8. Report on nursing home reimbursement. The |
Illinois
Department shall report annually to the General |
Assembly, no later than the
first Monday in April of 1982, and |
each year thereafter, in regard to:
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(a) the rate structure used by the Illinois Department |
to reimburse
nursing facilities;
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(b) changes in the rate structure for reimbursing |
nursing facilities;
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(c) the administrative and program costs of |
reimbursing nursing facilities;
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(d) the availability of beds in nursing facilities for |
public aid
recipients; and
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(e) the number of closings of nursing facilities, and |
the reasons
for those closings; and .
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(f) for years beginning 2025 and thereafter, drawing |
on all available information that evaluates, to the extent |
possible, nursing facility costs and revenue, including a |
focus on the period of initial implementation of the |
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payments and programs authorized in this Act. |
The requirement for reporting to the General Assembly |
shall be satisfied
by filing copies of the report
as required |
by Section 3.1 of the General Assembly Organization Act, and |
filing such
additional copies with the State Government Report |
Distribution Center for
the General Assembly as is required |
under paragraph (t) of Section 7 of the
State Library Act.
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(Source: P.A. 100-1148, eff. 12-10-18.)
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(305 ILCS 5/5B-2) (from Ch. 23, par. 5B-2)
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Sec. 5B-2. Assessment; no local authorization to tax.
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(a) For the privilege of engaging in the occupation of |
long-term care
provider, beginning July 1, 2011 through June |
30, 2022, or upon federal approval by the Centers for Medicare |
and Medicaid Services of the long-term care provider |
assessment described in subsection (a-1), whichever is later, |
an assessment is imposed upon each long-term care provider in |
an amount equal to $6.07 times the number of occupied bed days |
due and payable each month. Notwithstanding any provision of |
any other Act to the
contrary, this assessment shall be |
construed as a tax, but shall not be billed or passed on to any |
resident of a nursing home operated by the nursing home |
provider.
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(a-1) For the privilege of engaging in the occupation of |
long-term care provider for each occupied non-Medicare bed |
day, beginning July 1, 2022, an assessment is imposed upon |
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each long-term care provider in an amount varying with the |
number of paid Medicaid resident days per annum in the |
facility with the following schedule of occupied bed tax |
amounts. This assessment is due and payable each month. The |
tax shall follow the schedule below and be rebased by the |
Department on an annual basis. The Department shall publish |
each facility's rebased tax rate according to the schedule in |
this Section 30 days prior to the beginning of the 6-month |
period beginning July 1, 2022 and thereafter 30 days prior to |
the beginning of each calendar year which shall incorporate |
the number of paid Medicaid days used to determine each |
facility's rebased tax rate. |
(1) 0-5,000 paid Medicaid resident days per annum, |
$10.67. |
(2) 5,001-15,000 paid Medicaid resident days per |
annum, $19.20. |
(3) 15,001-35,000 paid Medicaid resident days per |
annum, $22.40. |
(4) 35,001-55,000 paid Medicaid resident days per |
annum, $19.20. |
(5) 55,001-65,000 paid Medicaid resident days per |
annum, $13.86. |
(6) 65,001+ paid Medicaid resident days per annum, |
$10.67. |
(7) Any non-profit nursing facilities without |
Medicaid-certified beds, $7 per occupied bed day. |
|
Notwithstanding any provision of any other Act to the |
contrary, this assessment shall be construed as a tax but |
shall not be billed or passed on to any resident of a nursing |
home operated by the nursing home provider. |
For each new calendar year and for the 6-month period |
beginning July 1, 2022, a facility's paid Medicaid resident |
days per annum shall be determined using the Department's |
Medicaid Management Information System to include Medicaid |
resident days for the year ending 9 months earlier. |
(b) Nothing in this amendatory Act of 1992 shall be |
construed to
authorize any home rule unit or other unit of |
local government to license
for revenue or impose a tax or |
assessment upon long-term care providers or
the occupation of |
long-term care provider, or a tax or assessment measured
by |
the income or earnings or occupied bed days of a long-term care |
provider.
|
(c) The assessment imposed by this Section shall not be |
due and payable, however, until after the Department notifies |
the long-term care providers, in writing, that the payment |
methodologies to long-term care providers required under |
Section 5-5.2 5-5.4 of this Code have been approved by the |
Centers for Medicare and Medicaid Services of the U.S. |
Department of Health and Human Services and that the waivers |
under 42 CFR 433.68 for the assessment imposed by this |
Section, if necessary, have been granted by the Centers for |
Medicare and Medicaid Services of the U.S. Department of |
|
Health and Human Services. |
(Source: P.A. 96-1530, eff. 2-16-11; 97-10, eff. 6-14-11; |
97-584, eff. 8-26-11.)
|
(305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)
|
Sec. 5B-4. Payment of assessment; penalty.
|
(a) The assessment imposed by Section 5B-2 shall be due |
and payable monthly, on the last State business day of the |
month for occupied bed days reported for the preceding third |
month prior to the month in which the tax is payable and due. A |
facility that has delayed payment due to the State's failure |
to reimburse for services rendered may request an extension on |
the due date for payment pursuant to subsection (b) and shall |
pay the assessment within 30 days of reimbursement by the |
Department.
The Illinois Department may provide that county |
nursing homes directed and
maintained pursuant to Section |
5-1005 of the Counties Code may meet their
assessment |
obligation by certifying to the Illinois Department that |
county
expenditures have been obligated for the operation of |
the county nursing
home in an amount at least equal to the |
amount of the assessment.
|
(a-5) The Illinois Department shall provide for an |
electronic submission process for each long-term care facility |
to report at a minimum the number of occupied bed days of the |
long-term care facility for the reporting period and other |
reasonable information the Illinois Department requires for |
|
the administration of its responsibilities under this Code. |
Beginning July 1, 2013, a separate electronic submission shall |
be completed for each long-term care facility in this State |
operated by a long-term care provider. The Illinois Department |
shall provide a self-reporting notice of the assessment form |
that the long-term care facility completes for the required |
period and submits with its assessment payment to the Illinois |
Department. To the extent practicable, the Department shall |
coordinate the assessment reporting requirements with other |
reporting required of long-term care facilities. |
(b) The Illinois Department is authorized to establish
|
delayed payment schedules for long-term care providers that |
are
unable to make assessment payments when due under this |
Section
due to financial difficulties, as determined by the |
Illinois
Department. The Illinois Department may not deny a |
request for delay of payment of the assessment imposed under |
this Article if the long-term care provider has not been paid |
by the State or the Medicaid managed care organization for |
services provided during the month on which the assessment is |
levied or the Medicaid managed care organization has not been |
paid by the State.
|
(c) If a long-term care provider fails to pay the full
|
amount of an assessment payment when due (including any |
extensions
granted under subsection (b)), there shall, unless |
waived by the
Illinois Department for reasonable cause, be |
added to the
assessment imposed by Section 5B-2 a
penalty |
|
assessment equal to the lesser of (i) 5% of the amount of
the |
assessment payment not paid on or before the due date plus 5% |
of the
portion thereof remaining unpaid on the last day of each |
month
thereafter or (ii) 100% of the assessment payment amount |
not paid on or
before the due date. For purposes of this |
subsection, payments
will be credited first to unpaid |
assessment payment amounts (rather than
to penalty or |
interest), beginning with the most delinquent assessment |
payments. Payment cycles of longer than 60 days shall be one |
factor the Director takes into account in granting a waiver |
under this Section.
|
(c-5) If a long-term care facility fails to file its |
assessment bill with payment, there shall, unless waived by |
the Illinois Department for reasonable cause, be added to the |
assessment due a penalty assessment equal to 25% of the |
assessment due. After July 1, 2013, no penalty shall be |
assessed under this Section if the Illinois Department does |
not provide a process for the electronic submission of the |
information required by subsection (a-5). |
(d) Nothing in this amendatory Act of 1993 shall be |
construed to prevent
the Illinois Department from collecting |
all amounts due under this Article
pursuant to an assessment |
imposed before the effective date of this amendatory
Act of |
1993.
|
(e) Nothing in this amendatory Act of the 96th General |
Assembly shall be construed to prevent
the Illinois Department |
|
from collecting all amounts due under this Code
pursuant to an |
assessment, tax, fee, or penalty imposed before the effective |
date of this amendatory
Act of the 96th General Assembly. |
(f) No installment of the assessment imposed by Section |
5B-2 shall be due and payable until after the Department |
notifies the long-term care providers, in writing, that the |
payment methodologies to long-term care providers required |
under Section 5-5.2 5-5.4 of this Code have been approved by |
the Centers for Medicare and Medicaid Services of the U.S. |
Department of Health and Human Services and the waivers under |
42 CFR 433.68 for the assessment imposed by this Section, if |
necessary, have been granted by the Centers for Medicare and |
Medicaid Services of the U.S. Department of Health and Human |
Services. Upon notification to the Department of approval of |
the payment methodologies required under Section 5-5.2 5-5.4 |
of this Code and the waivers granted under 42 CFR 433.68, all |
installments otherwise due under Section 5B-4 prior to the |
date of notification shall be due and payable to the |
Department upon written direction from the Department within |
90 days after issuance by the Comptroller of the payments |
required under Section 5-5.2 5-5.4 of this Code. |
(Source: P.A. 100-501, eff. 6-1-18; 101-649, eff. 7-7-20.)
|
(305 ILCS 5/5B-5) (from Ch. 23, par. 5B-5)
|
Sec. 5B-5. Annual reporting; penalty; maintenance of |
records.
|
|
(a) After December 31 of each year, and on or before
March |
31 of the succeeding year, every long-term care provider |
subject to
assessment under this Article shall file a report |
with the Illinois
Department. The report shall be in a form and |
manner prescribed by the Illinois Department and shall state |
the revenue received by the long-term care provider, reported |
in such categories as may be required by the Illinois |
Department, and other reasonable information the Illinois |
Department requires for the administration of its |
responsibilities under this Code.
|
(b) If a long-term care provider operates or maintains
|
more than one long-term care facility in this State, the |
provider
may not file a single return covering all those |
long-term care
facilities, but shall file a separate return |
for each
long-term care facility and shall compute and pay the |
assessment
for each long-term care facility separately.
|
(c) Notwithstanding any other provision in this Article, |
in
the case of a person who ceases to operate or maintain a |
long-term
care facility in respect of which the person is |
subject to
assessment under this Article as a long-term care |
provider, the person shall file a final, amended return with |
the Illinois
Department not more than 90 days after the |
cessation reflecting
the adjustment and shall pay with the |
final return the
assessment for the year as so adjusted (to the |
extent not
previously paid). If a person fails to file a final |
amended return on a timely basis, there shall, unless waived |
|
by the Illinois Department for reasonable cause, be added to |
the assessment due a penalty assessment equal to 25% of the |
assessment due.
|
(d) Notwithstanding any other provision of this Article, a
|
provider who commences operating or maintaining a long-term |
care
facility that was under a prior ownership and remained |
licensed by the Department of Public Health shall notify the |
Illinois Department of any the change in ownership regardless |
of percentage, and shall be responsible to immediately pay any |
prior amounts owed by the facility. In addition, beginning |
January 1, 2023, all providers operating or maintaining a |
long-term care facility shall notify the Illinois Department |
of all individual owners and any individuals or organizations |
that are part of a limited liability company with ownership of |
that facility and the percentage ownership of each owner. This |
ownership reporting requirement does not include individual |
shareholders in a publicly held corporation. Submission of the |
information as part of the Department's cost reporting |
requirements shall satisfy this requirement.
|
(e) The Department shall develop a procedure for sharing |
with a potential buyer of a facility information regarding |
outstanding assessments and penalties owed by that facility.
|
(f) In the case of a long-term care provider existing as a
|
corporation or legal entity other than an individual, the |
return
filed by it shall be signed by its president, |
vice-president,
secretary, or treasurer or by its properly |
|
authorized agent.
|
(g) If a long-term care provider fails to file its return
|
on or before the due date of the return,
there shall, unless |
waived by the Illinois Department for
reasonable cause, be |
added to the assessment imposed by Section
5B-2 a penalty |
assessment equal to 25%
of the assessment imposed for the |
year. After July 1, 2013, no penalty shall be assessed if the |
Illinois Department has not established a process for the |
electronic submission of information.
|
(h) Every long-term care provider subject to assessment
|
under this Article shall keep records and books that will
|
permit the determination of occupied bed days on a calendar |
year
basis. All such books and records shall be kept in the |
English
language and shall, at all times during business hours |
of the
day, be subject to inspection by the Illinois |
Department or its
duly authorized agents and employees.
|
(i) The Illinois Department shall establish a process for |
long-term care providers to electronically submit all |
information required by this Section no later than July 1, |
2013. |
(Source: P.A. 96-1530, eff. 2-16-11; 97-403, eff. 1-1-12; |
97-813, eff. 7-13-12.)
|
(305 ILCS 5/5B-8) (from Ch. 23, par. 5B-8)
|
Sec. 5B-8. Long-Term Care Provider Fund.
|
(a) There is created in the State Treasury the Long-Term
|
|
Care Provider Fund. Interest earned by the Fund shall be
|
credited to the Fund. The Fund shall not be used to replace any
|
moneys appropriated to the Medicaid program by the General |
Assembly.
|
(b) The Fund is created for the purpose of receiving and
|
disbursing moneys in accordance with this Article. |
Disbursements
from the Fund shall be made only as follows:
|
(1) For payments to nursing
facilities, including |
county nursing facilities but excluding
State-operated |
facilities, under Title XIX of the Social Security
Act and |
Article V of this Code.
|
(1.5) For payments to managed care organizations as |
defined in Section 5-30.1 of this Code.
|
(2) For the reimbursement of moneys collected by the
|
Illinois Department through error or mistake.
|
(3) For payment of administrative expenses incurred by |
the
Illinois Department or its agent in performing the |
activities
authorized by this Article.
|
(3.5) For reimbursement of expenses incurred by |
long-term care facilities, and payment of administrative |
expenses incurred by the Department of Public Health, in |
relation to the conduct and analysis of background checks |
for identified offenders under the Nursing Home Care Act.
|
(4) For payments of any amounts that are reimbursable |
to the
federal government for payments from this Fund that |
are required
to be paid by State warrant.
|
|
(5) For making transfers to the General Obligation |
Bond
Retirement and Interest Fund, as those transfers are |
authorized
in the proceedings authorizing debt under the |
Short Term Borrowing Act,
but transfers made under this |
paragraph (5) shall not exceed the
principal amount of |
debt issued in anticipation of the receipt by
the State of |
moneys to be deposited into the Fund.
|
(6) For making transfers, at the direction of the |
Director of the Governor's Office of Management and Budget |
during each fiscal year beginning on or after July 1, |
2011, to other State funds in an annual amount of |
$20,000,000 of the tax collected pursuant to this Article |
for the purpose of enforcement of nursing home standards, |
support of the ombudsman program, and efforts to expand |
home and community-based services. No transfer under this |
paragraph shall occur until (i) the payment methodologies |
created by Public Act 96-1530 under Section 5-5.4 of this |
Code have been approved by the Centers for Medicare and |
Medicaid Services of the U.S. Department of Health and |
Human Services and (ii) the assessment imposed by Section |
5B-2 of this Code is determined to be a permissible tax |
under Title XIX of the Social Security Act. |
Disbursements from the Fund, other than transfers made |
pursuant to paragraphs (5) and (6) of this subsection, shall |
be by
warrants drawn by the State Comptroller upon receipt of |
vouchers
duly executed and certified by the Illinois |
|
Department.
|
(c) The Fund shall consist of the following:
|
(1) All moneys collected or received by the Illinois
|
Department from the long-term care provider assessment |
imposed by
this Article.
|
(2) All federal matching funds received by the |
Illinois
Department as a result of expenditures made from |
the Fund by the Illinois
Department that are attributable |
to moneys deposited in the Fund.
|
(3) Any interest or penalty levied in conjunction with |
the
administration of this Article.
|
(4) (Blank).
|
(5) All other monies received for the Fund from any |
other source,
including interest earned thereon.
|
(Source: P.A. 96-1530, eff. 2-16-11; 97-584, eff. 8-26-11.)
|
(305 ILCS 5/5E-10)
|
Sec. 5E-10. Fee. Through June 30, 2022 or upon federal |
approval by the Centers for Medicare and Medicaid Services of |
the long-term care provider assessment described in subsection |
(a-1) of Section 5B-2 of this Code, whichever is later, every |
Every nursing home provider shall pay to the Illinois
|
Department, on or before September 10, December 10, March 10, |
and June 10, a
fee in the amount of $1.50 for each licensed |
nursing bed day for the calendar
quarter in which the payment |
is due. This fee shall not be billed or passed on
to any |