093_HB2657enr HB2657 Enrolled LRB093 04135 RCE 04178 b 1 AN ACT in relation to budget implementation. 2 Be it enacted by the People of the State of Illinois, 3 represented in the General Assembly: 4 Section 5. The Illinois Public Aid Code is amended by 5 changing Section 5-5.4 as follows: 6 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4) 7 Sec. 5-5.4. Standards of Payment - Department of Public 8 Aid. The Department of Public Aid shall develop standards of 9 payment of skilled nursing and intermediate care services in 10 facilities providing such services under this Article which: 11 (1) Provide for the determination of a facility's 12 payment for skilled nursing and intermediate care services on 13 a prospective basis. The amount of the payment rate for all 14 nursing facilities certified by the Department of Public 15 Health under the Nursing Home Care Act as Intermediate Care 16 for the Developmentally Disabled facilities, Long Term Care 17 for Under Age 22 facilities, Skilled Nursing facilities, or 18 Intermediate Care facilities under the medical assistance 19 program shall be prospectively established annually on the 20 basis of historical, financial, and statistical data 21 reflecting actual costs from prior years, which shall be 22 applied to the current rate year and updated for inflation, 23 except that the capital cost element for newly constructed 24 facilities shall be based upon projected budgets. The 25 annually established payment rate shall take effect on July 1 26 in 1984 and subsequent years. No rate increase and no update 27 for inflation shall be provided on or after July 1, 1994 and 28 before July 1, 2004, unless specifically provided for in this 29 Section. 30 For facilities licensed by the Department of Public 31 Health under the Nursing Home Care Act as Intermediate Care HB2657 Enrolled -2- LRB093 04135 RCE 04178 b 1 for the Developmentally Disabled facilities or Long Term Care 2 for Under Age 22 facilities, the rates taking effect on July 3 1, 1998 shall include an increase of 3%. For facilities 4 licensed by the Department of Public Health under the Nursing 5 Home Care Act as Skilled Nursing facilities or Intermediate 6 Care facilities, the rates taking effect on July 1, 1998 7 shall include an increase of 3% plus $1.10 per resident-day, 8 as defined by the Department. 9 For facilities licensed by the Department of Public 10 Health under the Nursing Home Care Act as Intermediate Care 11 for the Developmentally Disabled facilities or Long Term Care 12 for Under Age 22 facilities, the rates taking effect on July 13 1, 1999 shall include an increase of 1.6% plus $3.00 per 14 resident-day, as defined by the Department. For facilities 15 licensed by the Department of Public Health under the Nursing 16 Home Care Act as Skilled Nursing facilities or Intermediate 17 Care facilities, the rates taking effect on July 1, 1999 18 shall include an increase of 1.6% and, for services provided 19 on or after October 1, 1999, shall be increased by $4.00 per 20 resident-day, as defined by the Department. 21 For facilities licensed by the Department of Public 22 Health under the Nursing Home Care Act as Intermediate Care 23 for the Developmentally Disabled facilities or Long Term Care 24 for Under Age 22 facilities, the rates taking effect on July 25 1, 2000 shall include an increase of 2.5% per resident-day, 26 as defined by the Department. For facilities licensed by the 27 Department of Public Health under the Nursing Home Care Act 28 as Skilled Nursing facilities or Intermediate Care 29 facilities, the rates taking effect on July 1, 2000 shall 30 include an increase of 2.5% per resident-day, as defined by 31 the Department. 32 For facilities licensed by the Department of Public 33 Health under the Nursing Home Care Act as skilled nursing 34 facilities or intermediate care facilities, a new payment HB2657 Enrolled -3- LRB093 04135 RCE 04178 b 1 methodology must be implemented for the nursing component of 2 the rate effective July 1, 2003. The Department of Public Aid 3 shall develop the new payment methodology using the Minimum 4 Data Set (MDS) as the instrument to collect information 5 concerning nursing home resident condition necessary to 6 compute the rate. The Department of Public Aid shall develop 7 the new payment methodology to meet the unique needs of 8 Illinois nursing home residents while remaining subject to 9 the appropriations provided by the General Assembly. A 10 transition period from the payment methodology in effect on 11 June 30, 2003 to the payment methodology in effect on July 1, 12 2003 shall be provided for a period not exceeding 2 years 13 after implementation of the new payment methodology as 14 follows: 15 (A) For a facility that would receive a lower 16 nursing component rate per patient day under the new 17 system than the facility received effective on the date 18 immediately preceding the date that the Department 19 implements the new payment methodology, the nursing 20 component rate per patient day for the facility shall be 21 held at the level in effect on the date immediately 22 preceding the date that the Department implements the new 23 payment methodology until a higher nursing component rate 24 of reimbursement is achieved by that facility. 25 (B) For a facility that would receive a higher 26 nursing component rate per patient day under the payment 27 methodology in effect on July 1, 2003 than the facility 28 received effective on the date immediately preceding the 29 date that the Department implements the new payment 30 methodology, the nursing component rate per patient day 31 for the facility shall be adjusted. 32 (C) Notwithstanding paragraphs (A) and (B), the 33 nursing component rate per patient day for the facility 34 shall be adjusted subject to appropriations provided by HB2657 Enrolled -4- LRB093 04135 RCE 04178 b 1 the General Assembly. 2 For facilities licensed by the Department of Public 3 Health under the Nursing Home Care Act as Intermediate Care 4 for the Developmentally Disabled facilities or Long Term Care 5 for Under Age 22 facilities, the rates taking effect on March 6 1, 2001 shall include a statewide increase of 7.85%, as 7 defined by the Department. 8 For facilities licensed by the Department of Public 9 Health under the Nursing Home Care Act as Intermediate Care 10 for the Developmentally Disabled facilities or Long Term Care 11 for Under Age 22 facilities, the rates taking effect on April 12 1, 2002 shall include a statewide increase of 2.0%, as 13 defined by the Department. This increase terminates on July 14 1, 2002; beginning July 1, 2002 these rates are reduced to 15 the level of the rates in effect on March 31, 2002, as 16 defined by the Department. 17 For facilities licensed by the Department of Public 18 Health under the Nursing Home Care Act as skilled nursing 19 facilities or intermediate care facilities, the rates taking 20 effect on July 1, 2001 shall be computed using the most 21 recent cost reports on file with the Department of Public Aid 22 no later than April 1, 2000, updated for inflation to January 23 1, 2001. For rates effective July 1, 2001 only, rates shall 24 be the greater of the rate computed for July 1, 2001 or the 25 rate effective on June 30, 2001. 26 Notwithstanding any other provision of this Section, for 27 facilities licensed by the Department of Public Health under 28 the Nursing Home Care Act as skilled nursing facilities or 29 intermediate care facilities, the Illinois Department shall 30 determine by rule the rates taking effect on July 1, 2002, 31 which shall be 5.9% less than the rates in effect on June 30, 32 2002. 33 For facilities licensed by the Department of Public 34 Health under the Nursing Home Care Act as Intermediate Care HB2657 Enrolled -5- LRB093 04135 RCE 04178 b 1 for the Developmentally Disabled facilities or as long-term 2 care facilities for residents under 22 years of age, the 3 rates taking effect on July 1, 2003 shall include a statewide 4 increase of 4%, as defined by the Department. 5 Rates established effective each July 1 shall govern 6 payment for services rendered throughout that fiscal year, 7 except that rates established on July 1, 1996 shall be 8 increased by 6.8% for services provided on or after January 9 1, 1997. Such rates will be based upon the rates calculated 10 for the year beginning July 1, 1990, and for subsequent years 11 thereafter until June 30, 2001 shall be based on the facility 12 cost reports for the facility fiscal year ending at any point 13 in time during the previous calendar year, updated to the 14 midpoint of the rate year. The cost report shall be on file 15 with the Department no later than April 1 of the current rate 16 year. Should the cost report not be on file by April 1, the 17 Department shall base the rate on the latest cost report 18 filed by each skilled care facility and intermediate care 19 facility, updated to the midpoint of the current rate year. 20 In determining rates for services rendered on and after July 21 1, 1985, fixed time shall not be computed at less than zero. 22 The Department shall not make any alterations of regulations 23 which would reduce any component of the Medicaid rate to a 24 level below what that component would have been utilizing in 25 the rate effective on July 1, 1984. 26 (2) Shall take into account the actual costs incurred by 27 facilities in providing services for recipients of skilled 28 nursing and intermediate care services under the medical 29 assistance program. 30 (3) Shall take into account the medical and 31 psycho-social characteristics and needs of the patients. 32 (4) Shall take into account the actual costs incurred by 33 facilities in meeting licensing and certification standards 34 imposed and prescribed by the State of Illinois, any of its HB2657 Enrolled -6- LRB093 04135 RCE 04178 b 1 political subdivisions or municipalities and by the U.S. 2 Department of Health and Human Services pursuant to Title XIX 3 of the Social Security Act. 4 The Department of Public Aid shall develop precise 5 standards for payments to reimburse nursing facilities for 6 any utilization of appropriate rehabilitative personnel for 7 the provision of rehabilitative services which is authorized 8 by federal regulations, including reimbursement for services 9 provided by qualified therapists or qualified assistants, and 10 which is in accordance with accepted professional practices. 11 Reimbursement also may be made for utilization of other 12 supportive personnel under appropriate supervision. 13 (Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 14 92-597, eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 15 1-1-03; 93-20, eff. 6-20-03.) 16 Section 99. Effective date. This Act takes effect upon 17 becoming law.