HB2451 98TH GENERAL ASSEMBLY

LRB098 09092 KTG 39229 b

98TH GENERAL ASSEMBLY
State of Illinois
2013 and 2014
HB2451

Introduced 2/20/2013, by Rep. Lawrence M. Walsh, Jr.

SYNOPSIS AS INTRODUCED:

305 ILCS 5/5-5.4h new
305 ILCS 5/5-5.4i new
305 ILCS 5/5-5e

Amends the Medical Assistance Article of the Illinois Public Aid Code. Restores a provision that was previously repealed by Public Act 97-689 and that requires the Department of Healthcare and Family Services to promulgate rules that establish a policy of bed reserve payments to intermediate care facilities for the developmentally disabled (ICF/DDs) which address the needs of residents of ICF/DDs and their families. Restores a provision that was previously repealed by Public Act 97-689 and that requires the Department to approve bed reserves at a daily rate of 75% of an individual's current Medicaid per diem, for nursing facilities 90% or more of whose residents are Medicaid recipients and that have occupancy levels of at least 93% for resident bed reserves not exceeding 10 days. Removes a provision requiring the Department to cease payment for bed reserves in nursing facilities, specialized mental health rehabilitation facilities, and, except in the instance of residents who are under 21 years of age, intermediate care facilities for persons with developmental disabilities.

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 changing Section 5-5e and by adding Sections 5-5.4h and 5-5.4i as follows:

(305 ILCS 5/5-5.4h new)

Sec. 5-5.4h. Intermediate Care Facility for the Developmentally Disabled; bed reserve payments. The Department shall promulgate rules that establish a policy of bed reserve payments to ICF/DDs which addresses the needs of residents of ICF/DDs and their families.

(a) When a resident of an ICF/DD is absent from the facility in which he or she is a resident for purposes of physician authorized in-patient admission to a hospital, the Department's rules shall, at a minimum, provide (1) bed reserve payments at a daily rate which is 100% of the client's current per diem rate, for a period not exceeding 10 consecutive days; (2) bed reserve payments at a daily rate which is 75% of the client's current per diem rate, for a period which exceeds 10 consecutive days but does not exceed 30 consecutive days; and (3) bed reserve payments at a daily rate which is 50% of the client's current per diem rate for a period which exceeds 30 consecutive days but does not exceed 45 consecutive days.

(b) When a resident of an ICF/DD is absent from the facility in which he or she is a resident for purposes of a home visit with a family member, the Department's rules shall, at a minimum, provide (1) bed reserve payments at a rate which is 100% of the client's current per diem rate, for a period not exceeding 10 days per State fiscal year; and (2) bed reserve payments at a rate which is 75% of the client's current per diem rate, for a period which exceeds 10 days per State fiscal year but does not exceed 30 days per State fiscal year.

(c) No Department rule regarding bed reserve payments shall require an ICF/DD to have a specified percentage of total facility occupancy as a requirement for receiving bed reserve payments.

(d) This Section 5-5.4h shall not apply to any State operated facilities.

(305 ILCS 5/5-5.4i new)

Sec. 5-5.4i. Bed reserves; approval. The Department of Healthcare and Family Services shall approve bed reserves at a daily rate of 75% of an individual's current Medicaid per diem, for nursing facilities 90% or more of whose residents are Medicaid recipients and that have occupancy levels of at least 93% for resident bed reserves not exceeding 10 days.

(305 ILCS 5/5-5e)

Sec. 5-5e. Adjusted rates of reimbursement.

(a) Rates or payments for services in effect on June 30, 2012 shall be adjusted and services shall be affected as required by any other provision of this amendatory Act of the 97th General Assembly. In addition, the Department shall do the following:

(1) Delink the per diem rate paid for supportive living facility services from the per diem rate paid for nursing facility services, effective for services provided on or after May 1, 2011.

(2) (Blank). Cease payment for bed reserves in nursing facilities, specialized mental health rehabilitation facilities, and, except in the instance of residents who are under 21 years of age, intermediate care facilities for persons with developmental disabilities.

(3) Cease payment of the $10 per day add-on payment to nursing facilities for certain residents with developmental disabilities.

(b) After the application of subsection (a), notwithstanding any other provision of this Code to the contrary and to the extent permitted by federal law, on and after July 1, 2012, the rates of reimbursement for services and other payments provided under this Code shall further be reduced as follows:

(1) Rates or payments for physician services, dental services, or community health center services reimbursed through an encounter rate, and services provided under the Medicaid Rehabilitation Option of the Illinois Title XIX State Plan shall not be further reduced.

(2) Rates or payments, or the portion thereof, paid to a provider that is operated by a unit of local government or State University that provides the non-federal share of such services shall not be further reduced.

(3) Rates or payments for hospital services delivered by a hospital defined as a Safety-Net Hospital under Section 5-5e.1 of this Code shall not be further reduced.

(4) Rates or payments for hospital services delivered by a Critical Access Hospital, which is an Illinois hospital designated as a critical care hospital by the Department of Public Health in accordance with 42 CFR 485, Subpart F, shall not be further reduced.

(5) Rates or payments for Nursing Facility Services shall only be further adjusted pursuant to Section 5-5.2 of this Code.

(6) Rates or payments for services delivered by long term care facilities licensed under the ID/DD Community Care Act and developmental training services shall not be further reduced.

(7) Rates or payments for services provided under capitation rates shall be adjusted taking into consideration the rates reduction and covered services required by this amendatory Act of the 97th General Assembly.

(8) For hospitals not previously described in this subsection, the rates or payments for hospital services shall be further reduced by 3.5%, except for payments authorized under Section 5A-12.4 of this Code.

(9) For all other rates or payments for services delivered by providers not specifically referenced in paragraphs (1) through (8), rates or payments shall be further reduced by 2.7%.

(c) Any assessment imposed by this Code shall continue and nothing in this Section shall be construed to cause it to cease.

(Source: P.A. 97-689, eff. 6-14-12.)