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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Section 5-5.5 as follows: | ||||||
6 | (305 ILCS 5/5-5.5) (from Ch. 23, par. 5-5.5)
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7 | Sec. 5-5.5. Elements of Payment Rate.
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8 | (a) The The Department of Healthcare and Family Services | ||||||
9 | shall develop a prospective method for
determining payment | ||||||
10 | rates for skilled nursing and intermediate care
services in | ||||||
11 | nursing facilities composed of the following cost elements:
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12 | (1) Standard Services, with the cost of this component | ||||||
13 | being determined
by taking into account the actual costs to | ||||||
14 | the facilities of these services
subject to cost ceilings | ||||||
15 | to be defined in the Department's rules.
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16 | (2) Resident Services, with the cost of this component | ||||||
17 | being
determined by taking into account the actual costs, | ||||||
18 | needs and utilization
of these services, as derived from an | ||||||
19 | assessment of the resident needs in
the nursing facilities. | ||||||
20 | The Department shall adopt rules governing
reimbursement | ||||||
21 | for resident services as listed in Section 5-1.1. Surveys | ||||||
22 | or
assessments of resident needs under this Section shall | ||||||
23 | include a review by
the facility of the results of such |
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1 | assessments and a discussion of issues
in dispute with | ||||||
2 | authorized survey staff, unless the facility elects not to
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3 | participate in such a review process. Surveys or | ||||||
4 | assessments of resident
needs under this Section may be | ||||||
5 | conducted semi-annually and payment rates
relating to | ||||||
6 | resident services may be changed on a semi-annual basis. | ||||||
7 | The
Illinois Department shall initiate a project, either on | ||||||
8 | a pilot basis or
Statewide, to reimburse the cost of | ||||||
9 | resident services based on a
methodology which utilizes an | ||||||
10 | assessment of resident needs to determine the
level of | ||||||
11 | reimbursement. This methodology shall be different from | ||||||
12 | the
payment criteria for resident services utilized by the | ||||||
13 | Illinois Department
on July 1, 1981. On March 1, 1982, and | ||||||
14 | each year thereafter, until such
time when the Illinois | ||||||
15 | Department adopts the methodology used in such
project for | ||||||
16 | use statewide,
the Illinois Department shall report to the | ||||||
17 | General Assembly on the
implementation and progress of such | ||||||
18 | project. The report shall include:
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19 | (A) A statement of the Illinois Department's goals | ||||||
20 | and objectives
for such project;
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21 | (B) A description of such project, including the | ||||||
22 | number and type of
nursing facilities involved in the | ||||||
23 | project;
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24 | (C) A description of the methodology used in such | ||||||
25 | project;
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26 | (D) A description of the Illinois Department's |
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1 | application of the
methodology;
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2 | (E) A statement on the methodology's effect on the | ||||||
3 | quality of care
given to residents in the sample | ||||||
4 | nursing facilities; and
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5 | (F) A statement on the cost of the methodology used | ||||||
6 | in such project
and a comparison of this cost with the | ||||||
7 | cost of the current payment criteria.
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8 | (3) Ancillary Services, with the payment rate being | ||||||
9 | developed for
each individual type of service. Payment | ||||||
10 | shall be made only when
authorized under procedures | ||||||
11 | developed by the Department of Healthcare and Family | ||||||
12 | Services.
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13 | (4) Nurse's Aide Training, with the cost of this | ||||||
14 | component being
determined by taking into account the | ||||||
15 | actual cost to the facilities of
such training.
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16 | (5) Real Estate Taxes, with the cost of this component | ||||||
17 | being
determined by taking into account the figures | ||||||
18 | contained in the most
currently available cost reports | ||||||
19 | (with no imposition of maximums) updated
to the midpoint of | ||||||
20 | the current rate year for long term care services
rendered | ||||||
21 | between July 1, 1984 and June 30, 1985, and with the cost | ||||||
22 | of this
component being determined by taking into account | ||||||
23 | the actual 1983 taxes for
which the nursing homes were | ||||||
24 | assessed (with no imposition of maximums)
updated to the | ||||||
25 | midpoint of the current rate year for long term care
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26 | services rendered between July 1, 1985 and June 30, 1986.
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1 | (b) In developing a prospective method for determining | ||||||
2 | payment rates
for skilled nursing and intermediate care | ||||||
3 | services in nursing facilities,
the Department of Healthcare | ||||||
4 | and Family Services shall consider the following cost elements:
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5 | (1) Reasonable capital cost determined by utilizing | ||||||
6 | incurred interest
rate and the current value of the | ||||||
7 | investment, including land, utilizing
composite rates, or | ||||||
8 | by utilizing such other reasonable cost related methods
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9 | determined by the Department. However, beginning with the | ||||||
10 | rate
reimbursement period effective July 1, 1987, the | ||||||
11 | Department shall be
prohibited from establishing, | ||||||
12 | including, and implementing any depreciation
factor in | ||||||
13 | calculating the capital cost element.
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14 | (2) Profit, with the actual amount being produced and | ||||||
15 | accruing to
the providers in the form of a return on their | ||||||
16 | total investment, on the
basis of their ability to | ||||||
17 | economically and efficiently deliver a type
of service. The | ||||||
18 | method of payment may assure the opportunity for a
profit, | ||||||
19 | but shall not guarantee or establish a specific amount as a | ||||||
20 | cost.
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21 | (c) The Illinois Department may implement the amendatory | ||||||
22 | changes to
this Section made by this amendatory Act of 1991 | ||||||
23 | through the use of
emergency rules in accordance with the | ||||||
24 | provisions of Section 5.02 of the
Illinois Administrative | ||||||
25 | Procedure Act. For purposes of the Illinois
Administrative | ||||||
26 | Procedure Act, the adoption of rules to implement the
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1 | amendatory changes to this Section made by this amendatory
Act | ||||||
2 | of 1991 shall be deemed an emergency and necessary for the | ||||||
3 | public
interest, safety and welfare.
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4 | (d) No later than January 1, 2001, the Department of Public | ||||||
5 | Aid shall file
with the Joint Committee on Administrative | ||||||
6 | Rules, pursuant to the Illinois
Administrative Procedure
Act,
a | ||||||
7 | proposed rule, or a proposed amendment to an existing rule, | ||||||
8 | regarding payment
for appropriate services, including | ||||||
9 | assessment, care planning, discharge
planning, and treatment
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10 | provided by nursing facilities to residents who have a serious | ||||||
11 | mental
illness.
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12 | (Source: P.A. 95-331, eff. 8-21-07.)
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