101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB1785

 

Introduced 2/15/2019, by Sen. Omar Aquino

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-5.01a
305 ILCS 5/5-5e

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Medicaid rates for supportive living services on and after July 1, 2019 must be equal to 60% of the average total nursing facility services per diem for the geographic areas defined by the Department of Healthcare and Family Services. Provides that for supportive living facilities specializing in dementia care, the rate must be 72% instead of 60%. Requires the Medicaid rates for supportive living services to be updated whenever the total nursing facility service per diems are updated. Requires the Department to 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 through June 30, 2019 (rather than effective for services provided on or after May 1, 2011). Effective immediately.


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FISCAL NOTE ACT MAY APPLY

 

 

A BILL FOR

 

SB1785LRB101 11088 KTG 56301 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-5.01a and 5-5e as follows:
 
6    (305 ILCS 5/5-5.01a)
7    Sec. 5-5.01a. Supportive living facilities program.
8    (a) The Department shall establish and provide oversight
9for a program of supportive living facilities that seek to
10promote resident independence, dignity, respect, and
11well-being in the most cost-effective manner.
12    A supportive living facility is (i) a free-standing
13facility or (ii) a distinct physical and operational entity
14within a mixed-use building that meets the criteria established
15in subsection (d). A supportive living facility integrates
16housing with health, personal care, and supportive services and
17is a designated setting that offers residents their own
18separate, private, and distinct living units.
19    Sites for the operation of the program shall be selected by
20the Department based upon criteria that may include the need
21for services in a geographic area, the availability of funding,
22and the site's ability to meet the standards.
23    (b) Beginning July 1, 2014, subject to federal approval,

 

 

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1the Medicaid rates for supportive living facilities shall be
2equal to the supportive living facility Medicaid rate effective
3on June 30, 2014 increased by 8.85%. Once the assessment
4imposed at Article V-G of this Code is determined to be a
5permissible tax under Title XIX of the Social Security Act, the
6Department shall increase the Medicaid rates for supportive
7living facilities effective on July 1, 2014 by 9.09%. The
8Department shall apply this increase retroactively to coincide
9with the imposition of the assessment in Article V-G of this
10Code in accordance with the approval for federal financial
11participation by the Centers for Medicare and Medicaid
12Services.
13    The Medicaid rates for supportive living facilities
14effective on July 1, 2017 must be equal to the rates in effect
15for supportive living facilities on June 30, 2017 increased by
162.8%.
17    The Medicaid rates for supportive living facilities
18effective on July 1, 2018 must be equal to the rates in effect
19for supportive living facilities on June 30, 2018.
20    The Medicaid rates for supportive living services on and
21after July 1, 2019 must be equal to 60% of the average total
22nursing facility services per diem for the geographic areas
23defined by the Department. For supportive living facilities
24specializing in dementia care, the rate must be 72% instead of
2560%. The Medicaid rates for supportive living services must be
26updated whenever the total nursing facility service per diems

 

 

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1are updated.
2    (c) The Department may adopt rules to implement this
3Section. Rules that establish or modify the services,
4standards, and conditions for participation in the program
5shall be adopted by the Department in consultation with the
6Department on Aging, the Department of Rehabilitation
7Services, and the Department of Mental Health and Developmental
8Disabilities (or their successor agencies).
9    (d) Subject to federal approval by the Centers for Medicare
10and Medicaid Services, the Department shall accept for
11consideration of certification under the program any
12application for a site or building where distinct parts of the
13site or building are designated for purposes other than the
14provision of supportive living services, but only if:
15        (1) those distinct parts of the site or building are
16    not designated for the purpose of providing assisted living
17    services as required under the Assisted Living and Shared
18    Housing Act;
19        (2) those distinct parts of the site or building are
20    completely separate from the part of the building used for
21    the provision of supportive living program services,
22    including separate entrances;
23        (3) those distinct parts of the site or building do not
24    share any common spaces with the part of the building used
25    for the provision of supportive living program services;
26    and

 

 

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1        (4) those distinct parts of the site or building do not
2    share staffing with the part of the building used for the
3    provision of supportive living program services.
4    (e) Facilities or distinct parts of facilities which are
5selected as supportive living facilities and are in good
6standing with the Department's rules are exempt from the
7provisions of the Nursing Home Care Act and the Illinois Health
8Facilities Planning Act.
9(Source: P.A. 100-23, eff. 7-6-17; 100-583, eff. 4-6-18;
10100-587, eff. 6-4-18.)
 
11    (305 ILCS 5/5-5e)
12    Sec. 5-5e. Adjusted rates of reimbursement.
13    (a) Rates or payments for services in effect on June 30,
142012 shall be adjusted and services shall be affected as
15required by any other provision of Public Act 97-689. In
16addition, the Department shall do the following:
17        (1) Delink the per diem rate paid for supportive living
18    facility services from the per diem rate paid for nursing
19    facility services, effective for services provided on or
20    after May 1, 2011 through June 30, 2019.
21        (2) Cease payment for bed reserves in nursing
22    facilities and specialized mental health rehabilitation
23    facilities; for purposes of therapeutic home visits for
24    individuals scoring as TBI on the MDS 3.0, beginning June
25    1, 2015, the Department shall approve payments for bed

 

 

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1    reserves in nursing facilities and specialized mental
2    health rehabilitation facilities that have at least a 90%
3    occupancy level and at least 80% of their residents are
4    Medicaid eligible. Payment shall be at a daily rate of 75%
5    of an individual's current Medicaid per diem and shall not
6    exceed 10 days in a calendar month.
7        (2.5) Cease payment for bed reserves for purposes of
8    inpatient hospitalizations to intermediate care facilities
9    for persons with development disabilities, except in the
10    instance of residents who are under 21 years of age.
11        (3) Cease payment of the $10 per day add-on payment to
12    nursing facilities for certain residents with
13    developmental disabilities.
14    (b) After the application of subsection (a),
15notwithstanding any other provision of this Code to the
16contrary and to the extent permitted by federal law, on and
17after July 1, 2012, the rates of reimbursement for services and
18other payments provided under this Code shall further be
19reduced as follows:
20        (1) Rates or payments for physician services, dental
21    services, or community health center services reimbursed
22    through an encounter rate, and services provided under the
23    Medicaid Rehabilitation Option of the Illinois Title XIX
24    State Plan shall not be further reduced, except as provided
25    in Section 5-5b.1.
26        (2) Rates or payments, or the portion thereof, paid to

 

 

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1    a provider that is operated by a unit of local government
2    or State University that provides the non-federal share of
3    such services shall not be further reduced, except as
4    provided in Section 5-5b.1.
5        (3) Rates or payments for hospital services delivered
6    by a hospital defined as a Safety-Net Hospital under
7    Section 5-5e.1 of this Code shall not be further reduced,
8    except as provided in Section 5-5b.1.
9        (4) Rates or payments for hospital services delivered
10    by a Critical Access Hospital, which is an Illinois
11    hospital designated as a critical care hospital by the
12    Department of Public Health in accordance with 42 CFR 485,
13    Subpart F, shall not be further reduced, except as provided
14    in Section 5-5b.1.
15        (5) Rates or payments for Nursing Facility Services
16    shall only be further adjusted pursuant to Section 5-5.2 of
17    this Code.
18        (6) Rates or payments for services delivered by long
19    term care facilities licensed under the ID/DD Community
20    Care Act or the MC/DD Act and developmental training
21    services shall not be further reduced.
22        (7) Rates or payments for services provided under
23    capitation rates shall be adjusted taking into
24    consideration the rates reduction and covered services
25    required by Public Act 97-689.
26        (8) For hospitals not previously described in this

 

 

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1    subsection, the rates or payments for hospital services
2    shall be further reduced by 3.5%, except for payments
3    authorized under Section 5A-12.4 of this Code.
4        (9) For all other rates or payments for services
5    delivered by providers not specifically referenced in
6    paragraphs (1) through (8), rates or payments shall be
7    further reduced by 2.7%.
8    (c) Any assessment imposed by this Code shall continue and
9nothing in this Section shall be construed to cause it to
10cease.
11    (d) Notwithstanding any other provision of this Code to the
12contrary, subject to federal approval under Title XIX of the
13Social Security Act, for dates of service on and after July 1,
142014, rates or payments for services provided for the purpose
15of transitioning children from a hospital to home placement or
16other appropriate setting by a children's community-based
17health care center authorized under the Alternative Health Care
18Delivery Act shall be $683 per day.
19    (e) Notwithstanding any other provision of this Code to the
20contrary, subject to federal approval under Title XIX of the
21Social Security Act, for dates of service on and after July 1,
222014, rates or payments for home health visits shall be $72.
23    (f) Notwithstanding any other provision of this Code to the
24contrary, subject to federal approval under Title XIX of the
25Social Security Act, for dates of service on and after July 1,
262014, rates or payments for the certified nursing assistant

 

 

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1component of the home health agency rate shall be $20.
2(Source: P.A. 98-104, eff. 7-22-13; 98-651, eff. 6-16-14;
398-1166, eff. 6-1-15; 99-2, eff. 3-26-15; 99-180, eff. 7-29-15;
499-642, eff. 7-28-16.)
 
5    Section 99. Effective date. This Act takes effect upon
6becoming law.