HB3899 102ND GENERAL ASSEMBLY

LRB102 13708 KTG 19058 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB3899

Introduced 2/22/2021, by Rep. Anne Stava-Murray

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.2a new

Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall implement no later than July 1, 2021 a reimbursement system that uses the Medicare PDPM nursing component rate and 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, quality star rating, staffing star rating, and a quality component that rewards quality improvements. Defines "PDPM nursing component case mix index", "quality star rating", "staffing star rating", and other terms. Contains findings. Effective immediately.

FISCAL NOTE ACT MAY APPLY

A BILL FOR

AN ACT concerning public aid.

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 adding Sections 5-5.2a as follows:

(305 ILCS 5/5-5.2a new)

Sec. 5-5.2a. Nursing component.

(a) Findings. The General Assembly finds as follows:

(1) The intent of the $6.07 tax per occupied bed day imposed by Public Act 96-1530 was to pay for increased staffing under Public Act 96-1372.

(2) Many nursing homes are still staffed below the legal level required under Section 3-202.05 of the Nursing Home Care Act.

(3) Some low-staffed homes have gained from the higher Medicaid rates but have not increased staffing.

(4) Policy research has noted the significant positive relationship between nursing home staffing levels and quality of care.

(5) The use of regional wage adjusters rewards or penalizes nursing homes solely on location and does not account for staffing levels or actual wages paid.

(6) Building flexibility into a staffing rate component is needed to prevent a rate penalty in a pandemic that may cause understaffing.

(7) Creating a single assessment program maximizes federal revenue and minimizes losers within the system and must be done simultaneously with a new methodology.

(8) The State of Illinois desires to pay for value and quality of care within facilities, not just volume. It also sees the need to directly tie funding, rates, and incentives to demonstrable and sustained performance on key quality reporting metrics.

(9) Consideration should also be given to the concerns, inequities, and disparities that were brought to light during the COVID-19 pandemic.

(10) The General Assembly therefore finds and declares that an updated Nursing Home Medicaid payment methodology is in the best interest of the citizens of Illinois to review and update Medicaid payment methodologies to ensure the best use of public resources.

(b) Definitions. As used in this Section:

"Department" means the Department of Healthcare and Family Services or any successor agency which is designated as the single state Medicaid agency as required and defined under Title XIX of the Social Security Act.

"Medicare Five-Star Data" means the data used by the Centers for Medicare and Medicaid Services for the Five-Star Quality Rating System for nursing facilities and reported on Medicare's Nursing Home Compare website.

"Medicare PDPM nursing component rate" is Medicare's rural unadjusted PDPM nursing component rate published annually in the Federal Register and effective October 1. For each State fiscal year, the Department must use the rate effective October 1 immediately prior to July 1 for the quarters within the subsequent State fiscal year. For example, the rate published October 1, 2020 must be used for the 4 calendar quarters of State Fiscal Year 2022.

"PDPM" means the Patient Driven Payment Model which is the case mix classification model used by the Centers for Medicare and Medicaid Services for reimbursing skilled nursing facilities for Medicare-covered nursing facility services.

"PDPM nursing component case mix index" means the case weights assigned to groups under the nursing component of the PDPM case mix classification system.

"Quality star rating" means the overall quality rating for each nursing facility as assigned by the Centers for Medicare and Medicaid Services under the Five-Star Quality Rating System. The rating is on a scale of 1 to 5, with 1 being the worst rating and 5 being the best rating.

"Staffing star rating" means the overall staffing rating for each nursing facility as assigned by the Centers for Medicare and Medicaid Services under the Five-Star Quality Rating System. The rating is on a scale of 1 to 5, with 1 being the worst rating and 5 being the best rating.

(c) The Department shall implement no later than July 1, 2021 a reimbursement system that uses the Medicare PDPM nursing component rate and 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, quality star rating, staffing star rating, and a quality component that rewards quality improvements.

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