SB2541 EngrossedLRB101 18248 KTG 67690 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 Administrative Procedure Act is
5amended by adding Section 5-45.1 as follows:
 
6    (5 ILCS 100/5-45.1 new)
7    Sec. 5-45.1. Emergency rulemaking; ID/DD and MC/DD
8facility rates. To provide for the expeditious and timely
9implementation of changes made to Section 5-5.4 of the Illinois
10Public Aid Code by this amendatory Act of the 101st General
11Assembly, emergency rules implementing the changes made to
12Section 5-5.4 of the Illinois Public Aid Code by this
13amendatory Act of the 101st General Assembly may be adopted in
14accordance with Section 5-45 by the Department of Healthcare
15and Family Services. The adoption of emergency rules authorized
16by Section 5-45 and this Section is deemed to be necessary for
17the public interest, safety, and welfare.
18    This Section is repealed on January 1, 2026.
 
19    Section 10. The Illinois Public Aid Code is amended by
20changing Section 5-5.4 as follows:
 
21    (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)

 

 

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1    Sec. 5-5.4. Standards of Payment - Department of Healthcare
2and Family Services. The Department of Healthcare and Family
3Services shall develop standards of payment of nursing facility
4and ICF/DD services in facilities providing such services under
5this Article which:
6    (1) Provide for the determination of a facility's payment
7for nursing facility or ICF/DD services on a prospective basis.
8The amount of the payment rate for all nursing facilities
9certified by the Department of Public Health under the ID/DD
10Community Care Act or the Nursing Home Care Act as Intermediate
11Care for the Developmentally Disabled facilities, Long Term
12Care for Under Age 22 facilities, Skilled Nursing facilities,
13or Intermediate Care facilities under the medical assistance
14program shall be prospectively established annually on the
15basis of historical, financial, and statistical data
16reflecting actual costs from prior years, which shall be
17applied to the current rate year and updated for inflation,
18except that the capital cost element for newly constructed
19facilities shall be based upon projected budgets. The annually
20established payment rate shall take effect on July 1 in 1984
21and subsequent years. No rate increase and no update for
22inflation shall be provided on or after July 1, 1994, unless
23specifically provided for in this Section. The changes made by
24Public Act 93-841 extending the duration of the prohibition
25against a rate increase or update for inflation are effective
26retroactive to July 1, 2004.

 

 

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1    For facilities licensed by the Department of Public Health
2under the Nursing Home Care Act as Intermediate Care for the
3Developmentally Disabled facilities or Long Term Care for Under
4Age 22 facilities, the rates taking effect on July 1, 1998
5shall include an increase of 3%. For facilities licensed by the
6Department of Public Health under the Nursing Home Care Act as
7Skilled Nursing facilities or Intermediate Care facilities,
8the rates taking effect on July 1, 1998 shall include an
9increase of 3% plus $1.10 per resident-day, as defined by the
10Department. For facilities licensed by the Department of Public
11Health under the Nursing Home Care Act as Intermediate Care
12Facilities for the Developmentally Disabled or Long Term Care
13for Under Age 22 facilities, the rates taking effect on January
141, 2006 shall include an increase of 3%. For facilities
15licensed by the Department of Public Health under the Nursing
16Home Care Act as Intermediate Care Facilities for the
17Developmentally Disabled or Long Term Care for Under Age 22
18facilities, the rates taking effect on January 1, 2009 shall
19include an increase sufficient to provide a $0.50 per hour wage
20increase for non-executive staff. For facilities licensed by
21the Department of Public Health under the ID/DD Community Care
22Act as ID/DD Facilities the rates taking effect within 30 days
23after July 6, 2017 (the effective date of Public Act 100-23)
24shall include an increase sufficient to provide a $0.75 per
25hour wage increase for non-executive staff. The Department
26shall adopt rules, including emergency rules under subsection

 

 

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1(y) of Section 5-45 of the Illinois Administrative Procedure
2Act, to implement the provisions of this paragraph. For
3facilities licensed by the Department of Public Health under
4the ID/DD Community Care Act as ID/DD Facilities and under the
5MC/DD Act as MC/DD Facilities, the rates taking effect within
630 days after the effective date of this amendatory Act of the
7100th General Assembly shall include an increase sufficient to
8provide a $0.50 per hour wage increase for non-executive
9front-line personnel, including, but not limited to, direct
10support persons, aides, front-line supervisors, qualified
11intellectual disabilities professionals, nurses, and
12non-administrative support staff. The Department shall adopt
13rules, including emergency rules under subsection (bb) of
14Section 5-45 of the Illinois Administrative Procedure Act, to
15implement the provisions of this paragraph.
16    For facilities licensed by the Department of Public Health
17under the Nursing Home Care Act as Intermediate Care for the
18Developmentally Disabled facilities or Long Term Care for Under
19Age 22 facilities, the rates taking effect on July 1, 1999
20shall include an increase of 1.6% plus $3.00 per resident-day,
21as defined by the Department. For facilities licensed by the
22Department of Public Health under the Nursing Home Care Act as
23Skilled Nursing facilities or Intermediate Care facilities,
24the rates taking effect on July 1, 1999 shall include an
25increase of 1.6% and, for services provided on or after October
261, 1999, shall be increased by $4.00 per resident-day, as

 

 

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1defined by the Department.
2    For facilities licensed by the Department of Public Health
3under the Nursing Home Care Act as Intermediate Care for the
4Developmentally Disabled facilities or Long Term Care for Under
5Age 22 facilities, the rates taking effect on July 1, 2000
6shall include an increase of 2.5% per resident-day, as defined
7by the Department. For facilities licensed by the Department of
8Public Health under the Nursing Home Care Act as Skilled
9Nursing facilities or Intermediate Care facilities, the rates
10taking effect on July 1, 2000 shall include an increase of 2.5%
11per resident-day, as defined by the Department.
12    For facilities licensed by the Department of Public Health
13under the Nursing Home Care Act as skilled nursing facilities
14or intermediate care facilities, a new payment methodology must
15be implemented for the nursing component of the rate effective
16July 1, 2003. The Department of Public Aid (now Healthcare and
17Family Services) shall develop the new payment methodology
18using the Minimum Data Set (MDS) as the instrument to collect
19information concerning nursing home resident condition
20necessary to compute the rate. The Department shall develop the
21new payment methodology to meet the unique needs of Illinois
22nursing home residents while remaining subject to the
23appropriations provided by the General Assembly. A transition
24period from the payment methodology in effect on June 30, 2003
25to the payment methodology in effect on July 1, 2003 shall be
26provided for a period not exceeding 3 years and 184 days after

 

 

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1implementation of the new payment methodology as follows:
2        (A) For a facility that would receive a lower nursing
3    component rate per patient day under the new system than
4    the facility received effective on the date immediately
5    preceding the date that the Department implements the new
6    payment methodology, the nursing component rate per
7    patient day for the facility shall be held at the level in
8    effect on the date immediately preceding the date that the
9    Department implements the new payment methodology until a
10    higher nursing component rate of reimbursement is achieved
11    by that facility.
12        (B) For a facility that would receive a higher nursing
13    component rate per patient day under the payment
14    methodology in effect on July 1, 2003 than the facility
15    received effective on the date immediately preceding the
16    date that the Department implements the new payment
17    methodology, the nursing component rate per patient day for
18    the facility shall be adjusted.
19        (C) Notwithstanding paragraphs (A) and (B), the
20    nursing component rate per patient day for the facility
21    shall be adjusted subject to appropriations provided by the
22    General Assembly.
23    For facilities licensed by the Department of Public Health
24under the Nursing Home Care Act as Intermediate Care for the
25Developmentally Disabled facilities or Long Term Care for Under
26Age 22 facilities, the rates taking effect on March 1, 2001

 

 

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1shall include a statewide increase of 7.85%, as defined by the
2Department.
3    Notwithstanding any other provision of this Section, for
4facilities licensed by the Department of Public Health under
5the Nursing Home Care Act as skilled nursing facilities or
6intermediate care facilities, except facilities participating
7in the Department's demonstration program pursuant to the
8provisions of Title 77, Part 300, Subpart T of the Illinois
9Administrative Code, the numerator of the ratio used by the
10Department of Healthcare and Family Services to compute the
11rate payable under this Section using the Minimum Data Set
12(MDS) methodology shall incorporate the following annual
13amounts as the additional funds appropriated to the Department
14specifically to pay for rates based on the MDS nursing
15component methodology in excess of the funding in effect on
16December 31, 2006:
17        (i) For rates taking effect January 1, 2007,
18    $60,000,000.
19        (ii) For rates taking effect January 1, 2008,
20    $110,000,000.
21        (iii) For rates taking effect January 1, 2009,
22    $194,000,000.
23        (iv) For rates taking effect April 1, 2011, or the
24    first day of the month that begins at least 45 days after
25    the effective date of this amendatory Act of the 96th
26    General Assembly, $416,500,000 or an amount as may be

 

 

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1    necessary to complete the transition to the MDS methodology
2    for the nursing component of the rate. Increased payments
3    under this item (iv) are not due and payable, however,
4    until (i) the methodologies described in this paragraph are
5    approved by the federal government in an appropriate State
6    Plan amendment and (ii) the assessment imposed by Section
7    5B-2 of this Code is determined to be a permissible tax
8    under Title XIX of the Social Security Act.
9    Notwithstanding any other provision of this Section, for
10facilities licensed by the Department of Public Health under
11the Nursing Home Care Act as skilled nursing facilities or
12intermediate care facilities, the support component of the
13rates taking effect on January 1, 2008 shall be computed using
14the most recent cost reports on file with the Department of
15Healthcare and Family Services no later than April 1, 2005,
16updated for inflation to January 1, 2006.
17    For facilities licensed by the Department of Public Health
18under the Nursing Home Care Act as Intermediate Care for the
19Developmentally Disabled facilities or Long Term Care for Under
20Age 22 facilities, the rates taking effect on April 1, 2002
21shall include a statewide increase of 2.0%, as defined by the
22Department. This increase terminates on July 1, 2002; beginning
23July 1, 2002 these rates are reduced to the level of the rates
24in effect on March 31, 2002, as defined by the Department.
25    For facilities licensed by the Department of Public Health
26under the Nursing Home Care Act as skilled nursing facilities

 

 

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1or intermediate care facilities, the rates taking effect on
2July 1, 2001 shall be computed using the most recent cost
3reports on file with the Department of Public Aid no later than
4April 1, 2000, updated for inflation to January 1, 2001. For
5rates effective July 1, 2001 only, rates shall be the greater
6of the rate computed for July 1, 2001 or the rate effective on
7June 30, 2001.
8    Notwithstanding any other provision of this Section, for
9facilities licensed by the Department of Public Health under
10the Nursing Home Care Act as skilled nursing facilities or
11intermediate care facilities, the Illinois Department shall
12determine by rule the rates taking effect on July 1, 2002,
13which shall be 5.9% less than the rates in effect on June 30,
142002.
15    Notwithstanding any other provision of this Section, for
16facilities licensed by the Department of Public Health under
17the Nursing Home Care Act as skilled nursing facilities or
18intermediate care facilities, if the payment methodologies
19required under Section 5A-12 and the waiver granted under 42
20CFR 433.68 are approved by the United States Centers for
21Medicare and Medicaid Services, the rates taking effect on July
221, 2004 shall be 3.0% greater than the rates in effect on June
2330, 2004. These rates shall take effect only upon approval and
24implementation of the payment methodologies required under
25Section 5A-12.
26    Notwithstanding any other provisions of this Section, for

 

 

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1facilities licensed by the Department of Public Health under
2the Nursing Home Care Act as skilled nursing facilities or
3intermediate care facilities, the rates taking effect on
4January 1, 2005 shall be 3% more than the rates in effect on
5December 31, 2004.
6    Notwithstanding any other provision of this Section, for
7facilities licensed by the Department of Public Health under
8the Nursing Home Care Act as skilled nursing facilities or
9intermediate care facilities, effective January 1, 2009, the
10per diem support component of the rates effective on January 1,
112008, computed using the most recent cost reports on file with
12the Department of Healthcare and Family Services no later than
13April 1, 2005, updated for inflation to January 1, 2006, shall
14be increased to the amount that would have been derived using
15standard Department of Healthcare and Family Services methods,
16procedures, and inflators.
17    Notwithstanding any other provisions of this Section, for
18facilities licensed by the Department of Public Health under
19the Nursing Home Care Act as intermediate care facilities that
20are federally defined as Institutions for Mental Disease, or
21facilities licensed by the Department of Public Health under
22the Specialized Mental Health Rehabilitation Act of 2013, a
23socio-development component rate equal to 6.6% of the
24facility's nursing component rate as of January 1, 2006 shall
25be established and paid effective July 1, 2006. The
26socio-development component of the rate shall be increased by a

 

 

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1factor of 2.53 on the first day of the month that begins at
2least 45 days after January 11, 2008 (the effective date of
3Public Act 95-707). As of August 1, 2008, the socio-development
4component rate shall be equal to 6.6% of the facility's nursing
5component rate as of January 1, 2006, multiplied by a factor of
63.53. For services provided on or after April 1, 2011, or the
7first day of the month that begins at least 45 days after the
8effective date of this amendatory Act of the 96th General
9Assembly, whichever is later, the Illinois Department may by
10rule adjust these socio-development component rates, and may
11use different adjustment methodologies for those facilities
12participating, and those not participating, in the Illinois
13Department's demonstration program pursuant to the provisions
14of Title 77, Part 300, Subpart T of the Illinois Administrative
15Code, but in no case may such rates be diminished below those
16in effect on August 1, 2008.
17    For facilities licensed by the Department of Public Health
18under the Nursing Home Care Act as Intermediate Care for the
19Developmentally Disabled facilities or as long-term care
20facilities for residents under 22 years of age, the rates
21taking effect on July 1, 2003 shall include a statewide
22increase of 4%, as defined by the Department.
23    For facilities licensed by the Department of Public Health
24under the Nursing Home Care Act as Intermediate Care for the
25Developmentally Disabled facilities or Long Term Care for Under
26Age 22 facilities, the rates taking effect on the first day of

 

 

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1the month that begins at least 45 days after the effective date
2of this amendatory Act of the 95th General Assembly shall
3include a statewide increase of 2.5%, as defined by the
4Department.
5    Notwithstanding any other provision of this Section, for
6facilities licensed by the Department of Public Health under
7the Nursing Home Care Act as skilled nursing facilities or
8intermediate care facilities, effective January 1, 2005,
9facility rates shall be increased by the difference between (i)
10a facility's per diem property, liability, and malpractice
11insurance costs as reported in the cost report filed with the
12Department of Public Aid and used to establish rates effective
13July 1, 2001 and (ii) those same costs as reported in the
14facility's 2002 cost report. These costs shall be passed
15through to the facility without caps or limitations, except for
16adjustments required under normal auditing procedures.
17    Rates established effective each July 1 shall govern
18payment for services rendered throughout that fiscal year,
19except that rates established on July 1, 1996 shall be
20increased by 6.8% for services provided on or after January 1,
211997. Such rates will be based upon the rates calculated for
22the year beginning July 1, 1990, and for subsequent years
23thereafter until June 30, 2001 shall be based on the facility
24cost reports for the facility fiscal year ending at any point
25in time during the previous calendar year, updated to the
26midpoint of the rate year. The cost report shall be on file

 

 

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1with the Department no later than April 1 of the current rate
2year. Should the cost report not be on file by April 1, the
3Department shall base the rate on the latest cost report filed
4by each skilled care facility and intermediate care facility,
5updated to the midpoint of the current rate year. In
6determining rates for services rendered on and after July 1,
71985, fixed time shall not be computed at less than zero. The
8Department shall not make any alterations of regulations which
9would reduce any component of the Medicaid rate to a level
10below what that component would have been utilizing in the rate
11effective on July 1, 1984.
12    (2) Shall take into account the actual costs incurred by
13facilities in providing services for recipients of skilled
14nursing and intermediate care services under the medical
15assistance program.
16    (3) Shall take into account the medical and psycho-social
17characteristics and needs of the patients.
18    (4) Shall take into account the actual costs incurred by
19facilities in meeting licensing and certification standards
20imposed and prescribed by the State of Illinois, any of its
21political subdivisions or municipalities and by the U.S.
22Department of Health and Human Services pursuant to Title XIX
23of the Social Security Act.
24    The Department of Healthcare and Family Services shall
25develop precise standards for payments to reimburse nursing
26facilities for any utilization of appropriate rehabilitative

 

 

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1personnel for the provision of rehabilitative services which is
2authorized by federal regulations, including reimbursement for
3services provided by qualified therapists or qualified
4assistants, and which is in accordance with accepted
5professional practices. Reimbursement also may be made for
6utilization of other supportive personnel under appropriate
7supervision.
8    The Department shall develop enhanced payments to offset
9the additional costs incurred by a facility serving exceptional
10need residents and shall allocate at least $4,000,000 of the
11funds collected from the assessment established by Section 5B-2
12of this Code for such payments. For the purpose of this
13Section, "exceptional needs" means, but need not be limited to,
14ventilator care and traumatic brain injury care. The enhanced
15payments for exceptional need residents under this paragraph
16are not due and payable, however, until (i) the methodologies
17described in this paragraph are approved by the federal
18government in an appropriate State Plan amendment and (ii) the
19assessment imposed by Section 5B-2 of this Code is determined
20to be a permissible tax under Title XIX of the Social Security
21Act.
22    Beginning January 1, 2014 the methodologies for
23reimbursement of nursing facility services as provided under
24this Section 5-5.4 shall no longer be applicable for services
25provided on or after January 1, 2014.
26    No payment increase under this Section for the MDS

 

 

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1methodology, exceptional care residents, or the
2socio-development component rate established by Public Act
396-1530 of the 96th General Assembly and funded by the
4assessment imposed under Section 5B-2 of this Code shall be due
5and payable until after the Department notifies the long-term
6care providers, in writing, that the payment methodologies to
7long-term care providers required under this Section have been
8approved by the Centers for Medicare and Medicaid Services of
9the U.S. Department of Health and Human Services and the
10waivers under 42 CFR 433.68 for the assessment imposed by this
11Section, if necessary, have been granted by the Centers for
12Medicare and Medicaid Services of the U.S. Department of Health
13and Human Services. Upon notification to the Department of
14approval of the payment methodologies required under this
15Section and the waivers granted under 42 CFR 433.68, all
16increased payments otherwise due under this Section prior to
17the date of notification shall be due and payable within 90
18days of the date federal approval is received.
19    On and after July 1, 2012, the Department shall reduce any
20rate of reimbursement for services or other payments or alter
21any methodologies authorized by this Code to reduce any rate of
22reimbursement for services or other payments in accordance with
23Section 5-5e.
24    For facilities licensed by the Department of Public Health
25under the ID/DD Community Care Act as ID/DD Facilities and
26under the MC/DD Act as MC/DD Facilities, subject to federal

 

 

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1approval, the rates taking effect for services delivered on or
2after August 1, 2019 shall be increased by 3.5% over the rates
3in effect on June 30, 2019. The Department shall adopt rules,
4including emergency rules under subsection (ii) of Section 5-45
5of the Illinois Administrative Procedure Act, to implement the
6provisions of this Section, including wage increases for direct
7care staff.
8    For facilities licensed by the Department of Public Health
9under the ID/DD Community Care Act as ID/DD Facilities and
10under the MC/DD Act as MC/DD Facilities, subject to federal
11approval, the rates taking effect on the latter of the approval
12date of the State Plan Amendment for these facilities or the
13Waiver Amendment for the home and community-based services
14settings shall include an increase sufficient to provide a
15$0.26 per hour wage increase to the base wage for non-executive
16staff. The Department shall adopt rules, including emergency
17rules under subsection (ii) of Section 5-45 of the Illinois
18Administrative Procedure Act, to implement the provisions of
19this Section, including wage increases for direct care staff.
20(Source: P.A. 100-23, eff. 7-6-17; 100-587, eff. 6-4-18;
21101-10, eff. 6-5-19.)
 
22    Section 99. Effective date. This Act takes effect upon
23becoming law.