Sen. Ann Gillespie

Filed: 11/29/2022

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 4846

2    AMENDMENT NO. ______. Amend House Bill 4846 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Administrative Procedure Act is
5amended by adding Section 5-45.35 as follows:
 
6    (5 ILCS 100/5-45.35 new)
7    Sec. 5-45.35. Emergency rulemaking; rural emergency
8hospitals. To provide for the expeditious and timely
9implementation of this amendatory Act of the 102nd General
10Assembly, emergency rules implementing the inclusion of rural
11emergency hospitals in the definition of "hospital" in Section
123 of the Hospital Licensing Act may be adopted in accordance
13with Section 5-45 by the Department of Public Health. The
14adoption of emergency rules authorized by Section 5-45 and
15this Section is deemed to be necessary for the public
16interest, safety, and welfare.

 

 

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1    This Section is repealed one year after the effective date
2of this amendatory Act of the 102nd General Assembly.
 
3    Section 10. The Hospital Licensing Act is amended by
4changing Section 3 as follows:
 
5    (210 ILCS 85/3)
6    Sec. 3. As used in this Act:
7    (A) "Hospital" means any institution, place, building,
8buildings on a campus, or agency, public or private, whether
9organized for profit or not, devoted primarily to the
10maintenance and operation of facilities for the diagnosis and
11treatment or care of 2 or more unrelated persons admitted for
12overnight stay or longer in order to obtain medical, including
13obstetric, psychiatric and nursing, care of illness, disease,
14injury, infirmity, or deformity.
15    The term "hospital", without regard to length of stay,
16shall also include:
17        (a) any facility which is devoted primarily to
18    providing psychiatric and related services and programs
19    for the diagnosis and treatment or care of 2 or more
20    unrelated persons suffering from emotional or nervous
21    diseases;
22        (b) all places where pregnant females are received,
23    cared for, or treated during delivery irrespective of the
24    number of patients received; and .

 

 

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1        (c) on and after January 1, 2023, a rural emergency
2    hospital, as that term is defined under subsection
3    (kkk)(2) of Section 1861 of the federal Social Security
4    Act; to provide for the expeditious and timely
5    implementation of this amendatory Act of the 102nd General
6    Assembly, emergency rules to implement the changes made to
7    the definition of "hospital" by this amendatory Act of the
8    102nd General Assembly may be adopted by the Department
9    subject to the provisions of Section 5-45 of the Illinois
10    Administrative Procedure Act.
11    The term "hospital" includes general and specialized
12hospitals, tuberculosis sanitaria, mental or psychiatric
13hospitals and sanitaria, and includes maternity homes,
14lying-in homes, and homes for unwed mothers in which care is
15given during delivery.
16    The term "hospital" does not include:
17        (1) any person or institution required to be licensed
18    pursuant to the Nursing Home Care Act, the Specialized
19    Mental Health Rehabilitation Act of 2013, the ID/DD
20    Community Care Act, or the MC/DD Act;
21        (2) hospitalization or care facilities maintained by
22    the State or any department or agency thereof, where such
23    department or agency has authority under law to establish
24    and enforce standards for the hospitalization or care
25    facilities under its management and control;
26        (3) hospitalization or care facilities maintained by

 

 

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1    the federal government or agencies thereof;
2        (4) hospitalization or care facilities maintained by
3    any university or college established under the laws of
4    this State and supported principally by public funds
5    raised by taxation;
6        (5) any person or facility required to be licensed
7    pursuant to the Substance Use Disorder Act;
8        (6) any facility operated solely by and for persons
9    who rely exclusively upon treatment by spiritual means
10    through prayer, in accordance with the creed or tenets of
11    any well-recognized church or religious denomination;
12        (7) an Alzheimer's disease management center
13    alternative health care model licensed under the
14    Alternative Health Care Delivery Act; or
15        (8) any veterinary hospital or clinic operated by a
16    veterinarian or veterinarians licensed under the
17    Veterinary Medicine and Surgery Practice Act of 2004 or
18    maintained by a State-supported or publicly funded
19    university or college.
20    (B) "Person" means the State, and any political
21subdivision or municipal corporation, individual, firm,
22partnership, corporation, company, association, or joint stock
23association, or the legal successor thereof.
24    (C) "Department" means the Department of Public Health of
25the State of Illinois.
26    (D) "Director" means the Director of Public Health of the

 

 

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1State of Illinois.
2    (E) "Perinatal" means the period of time between the
3conception of an infant and the end of the first month after
4birth.
5    (F) "Federally designated organ procurement agency" means
6the organ procurement agency designated by the Secretary of
7the U.S. Department of Health and Human Services for the
8service area in which a hospital is located; except that in the
9case of a hospital located in a county adjacent to Wisconsin
10which currently contracts with an organ procurement agency
11located in Wisconsin that is not the organ procurement agency
12designated by the U.S. Secretary of Health and Human Services
13for the service area in which the hospital is located, if the
14hospital applies for a waiver pursuant to 42 U.S.C. USC
151320b-8(a), it may designate an organ procurement agency
16located in Wisconsin to be thereafter deemed its federally
17designated organ procurement agency for the purposes of this
18Act.
19    (G) "Tissue bank" means any facility or program operating
20in Illinois that is certified by the American Association of
21Tissue Banks or the Eye Bank Association of America and is
22involved in procuring, furnishing, donating, or distributing
23corneas, bones, or other human tissue for the purpose of
24injecting, transfusing, or transplanting any of them into the
25human body. "Tissue bank" does not include a licensed blood
26bank. For the purposes of this Act, "tissue" does not include

 

 

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1organs.
2    (H) "Campus", as this term terms applies to operations,
3has the same meaning as the term "campus" as set forth in
4federal Medicare regulations, 42 CFR 413.65.
5(Source: P.A. 99-180, eff. 7-29-15; 100-759, eff. 1-1-19.)
 
6    Section 15. The Behavior Analyst Licensing Act is amended
7by changing Sections 30, 35, and 150 as follows:
 
8    (225 ILCS 6/30)
9    (Section scheduled to be repealed on January 1, 2028)
10    Sec. 30. Qualifications for behavior analyst license.
11    (a) A person qualifies to be licensed as a behavior
12analyst if that person:
13        (1) has applied in writing or electronically on forms
14    prescribed by the Department;
15        (2) is a graduate of a graduate level program in the
16    field of behavior analysis or a related field with an
17    equivalent course of study in behavior analysis approved
18    by the Department from a regionally accredited university
19    approved by the Department;
20        (3) has completed at least 500 hours of supervision of
21    behavior analysis, as defined by rule;
22        (4) has qualified for and passed the examination for
23    the practice of behavior analysis as authorized by the
24    Department; and

 

 

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1        (5) has paid the required fees.
2    (b) The Department may issue a license to a certified
3behavior analyst seeking licensure as a licensed behavior
4analyst who (i) does not have the supervised experience as
5described in paragraph (3) of subsection (a), (ii) applies for
6licensure before July 1, 2028, and (iii) has completed all of
7the following:
8        (1) has applied in writing or electronically on forms
9    prescribed by the Department;
10        (2) is a graduate of a graduate level program in the
11    field of behavior analysis from a regionally accredited
12    university approved by the Department;
13        (3) submits evidence of certification by an
14    appropriate national certifying body as determined by rule
15    of the Department;
16        (4) has passed the examination for the practice of
17    behavior analysis as authorized by the Department; and
18        (5) has paid the required fees.
19    (c) An applicant has 3 years after the date of application
20to complete the application process. If the process has not
21been completed in 3 years, the application shall be denied,
22the fee shall be forfeited, and the applicant must reapply and
23meet the requirements in effect at the time of reapplication.
24    (d) Each applicant for licensure as a an behavior analyst
25shall have his or her fingerprints submitted to the Illinois
26State Police in an electronic format that complies with the

 

 

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1form and manner for requesting and furnishing criminal history
2record information as prescribed by the Illinois State Police.
3These fingerprints shall be transmitted through a live scan
4fingerprint vendor licensed by the Department. These
5fingerprints shall be checked against the Illinois State
6Police and Federal Bureau of Investigation criminal history
7record databases now and hereafter filed, including, but not
8limited to, civil, criminal, and latent fingerprint databases.
9The Illinois State Police shall charge a fee for conducting
10the criminal history records check, which shall be deposited
11in the State Police Services Fund and shall not exceed the
12actual cost of the records check. The Illinois State Police
13shall furnish, pursuant to positive identification, records of
14Illinois convictions as prescribed under the Illinois Uniform
15Conviction Information Act and shall forward the national
16criminal history record information to the Department.
17(Source: P.A. 102-953, eff. 5-27-22; revised 8-19-22.)
 
18    (225 ILCS 6/35)
19    (Section scheduled to be repealed on January 1, 2028)
20    Sec. 35. Qualifications for assistant behavior analyst
21license.
22    (a) A person qualifies to be licensed as an assistant
23behavior analyst if that person:
24        (1) has applied in writing or electronically on forms
25    prescribed by the Department;

 

 

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1        (2) is a graduate of a bachelor's level program in the
2    field of behavior analysis or a related field with an
3    equivalent course of study in behavior analysis approved
4    by the Department from a regionally accredited university
5    approved by the Department;
6        (3) has met the supervised work experience;
7        (4) has qualified for and passed the examination for
8    the practice of behavior analysis as a licensed assistant
9    behavior analyst as authorized by the Department; and
10        (5) has paid the required fees.
11    (b) The Department may issue a license to a certified
12assistant behavior analyst seeking licensure as a licensed
13assistant behavior analyst who (i) does not have the
14supervised experience as described in paragraph (3) of
15subsection (a), (ii) applies for licensure before July 1,
162028, and (iii) has completed all of the following:
17        (1) has applied in writing or electronically on forms
18    prescribed by the Department;
19        (2) is a graduate of a bachelor's bachelors level
20    program in the field of behavior analysis;
21        (3) submits evidence of certification by an
22    appropriate national certifying body as determined by rule
23    of the Department;
24        (4) has passed the examination for the practice of
25    behavior analysis as authorized by the Department; and
26        (5) has paid the required fees.

 

 

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1    (c) An applicant has 3 years after the date of application
2to complete the application process. If the process has not
3been completed in 3 years, the application shall be denied,
4the fee shall be forfeited, and the applicant must reapply and
5meet the requirements in effect at the time of reapplication.
6    (d) Each applicant for licensure as an assistant behavior
7analyst shall have his or her fingerprints submitted to the
8Illinois State Police in an electronic format that complies
9with the form and manner for requesting and furnishing
10criminal history record information as prescribed by the
11Illinois State Police. These fingerprints shall be transmitted
12through a live scan fingerprint vendor licensed by the
13Department. These fingerprints shall be checked against the
14Illinois State Police and Federal Bureau of Investigation
15criminal history record databases now and hereafter filed,
16including, but not limited to, civil, criminal, and latent
17fingerprint databases. The Illinois State Police shall charge
18a fee for conducting the criminal history records check, which
19shall be deposited in the State Police Services Fund and shall
20not exceed the actual cost of the records check. The Illinois
21State Police shall furnish, pursuant to positive
22identification, records of Illinois convictions as prescribed
23under the Illinois Uniform Conviction Information Act and
24shall forward the national criminal history record information
25to the Department.
26(Source: P.A. 102-953, eff. 5-27-22; revised 8-19-22.)
 

 

 

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1    (225 ILCS 6/150)
2    (Section scheduled to be repealed on January 1, 2028)
3    Sec. 150. License restrictions and limitations.
4Notwithstanding the exclusion in paragraph (2) of subsection
5(c) of Section 20 that permits an individual to implement a
6behavior analytic treatment plan under the extended authority,
7direction, and supervision of a licensed behavior analyst or
8licensed assistant behavior analyst, no No business
9organization shall provide, attempt to provide, or offer to
10provide behavior analysis services unless every member,
11partner, shareholder, director, officer, holder of any other
12ownership interest, agent, and employee who renders applied
13behavior analysis services holds a currently valid license
14issued under this Act. No business shall be created that (i)
15has a stated purpose that includes behavior analysis, or (ii)
16practices or holds itself out as available to practice
17behavior analysis therapy, unless it is organized under the
18Professional Service Corporation Act or Professional Limited
19Liability Company Act. Nothing in this Act shall preclude
20individuals licensed under this Act from practicing directly
21or indirectly for a physician licensed to practice medicine in
22all its branches under the Medical Practice Act of 1987 or for
23any legal entity as provided under subsection (c) of Section
2422.2 of the Medical Practice Act of 1987.
25(Source: P.A. 102-953, eff. 5-27-22.)
 

 

 

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1    Section 20. The Podiatric Medical Practice Act of 1987 is
2amended by adding Section 18.1 as follows:
 
3    (225 ILCS 100/18.1 new)
4    Sec. 18.1. Fee waivers. Notwithstanding any provision of
5law to the contrary, during State Fiscal Year 2023, the
6Department shall allow individuals a one-time waiver of fees
7imposed under Section 18 of this Act. No individual may
8benefit from such a waiver more than once. If an individual has
9already paid a fee required under Section 18 for Fiscal Year
102023, then the Department shall apply the money paid for that
11fee as a credit to the next required fee.
 
12    Section 25. The Nurse Agency Licensing Act is amended by
13changing Sections 3, 14, and 14.3 as follows:
 
14    (225 ILCS 510/3)  (from Ch. 111, par. 953)
15    Sec. 3. Definitions. As used in this Act:
16    "Certified nurse aide" means an individual certified as
17defined in Section 3-206 of the Nursing Home Care Act, Section
183-206 of the ID/DD Community Care Act, or Section 3-206 of the
19MC/DD Act, as now or hereafter amended.
20    "Covenant not to compete" means an agreement between a
21nurse agency and an employee that restricts the employee from
22performing:

 

 

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1        (1) any work for another employer for a specified
2    period of time;
3        (2) any work in a specified geographic area; or
4        (3) any work for another employer that is similar to
5    the work the employee performs for the employer that is a
6    party to the agreement.
7    "Department" means the Department of Labor.
8    "Director" means the Director of Labor.
9    "Employee" means a nurse or a certified nurse aide.
10    "Health care facility" is defined as in Section 3 of the
11Illinois Health Facilities Planning Act, as now or hereafter
12amended. "Health care facility" also includes any facility
13licensed, certified, or approved by any State agency and
14subject to regulation under the Assisted Living and Shared
15Housing Act or the Illinois Public Aid Code.
16    "Licensee" means any nurse nursing agency which is
17properly licensed under this Act.
18    "Long-term basis" means an initial employment, assignment,
19or referral term of more than 24 continuous months.
20    "Nurse" means a registered nurse, a licensed practical
21nurse, an advanced practice registered nurse, or any
22individual licensed under the Nurse Practice Act.
23    "Nurse agency" means any individual, firm, corporation,
24partnership, or other legal entity that employs, assigns, or
25refers nurses or certified nurse aides to a health care
26facility for a fee. The term "nurse agency" includes nurses

 

 

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1registries. The term "nurse agency" does not include services
2provided by home health agencies licensed and operated under
3the Home Health, Home Services, and Home Nursing Agency
4Licensing Act or a licensed or certified individual who
5provides his or her own services as a regular employee of a
6health care facility, nor does it apply to a health care
7facility's organizing nonsalaried employees to provide
8services only in that facility.
9    "Temporary basis" means an initial employment, assignment,
10or referral term of 24 continuous months or less exclusive of
11any extension.
12(Source: P.A. 102-946, eff. 7-1-22.)
 
13    (225 ILCS 510/14)  (from Ch. 111, par. 964)
14    Sec. 14. Minimum Standards.
15    (a) The Department, by rule, shall establish minimum
16standards for the operation of nurse agencies. Those standards
17shall include, but are not limited to:
18        (1) the maintenance of written policies and
19    procedures;
20        (2) the maintenance and submission to the Department
21    of copies of all contracts between the nurse agency and
22    health care facility to which it assigns or refers nurses
23    or certified nurse aides and copies of all invoices to
24    health care facilities personnel. Executed contracts must
25    be sent to the Department within 5 business days of their

 

 

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1    effective date; and
2        (3) the development of personnel policies for nurses
3    or certified nurse aides employed, assigned, or referred
4    to health care facilities, including a personal interview,
5    a reference check, an annual evaluation of each employee
6    (which may be based in part upon information provided by
7    health care facilities utilizing nurse agency personnel),
8    and periodic health examinations. Executed contracts must
9    be sent to the Department within 5 business days of their
10    effective date and are not subject to disclosure under the
11    Freedom of Information Act; and .
12        (4) a requirement that no No less than 100% of the
13    nurse or certified nurse aide hourly rate shall be paid to
14    the nurse or certified nurse aide employee.
15    The requirements to maintain and submit contracts and
16invoices to the Department under subparagraphs (2) and (3) of
17this subsection do not apply to (i) contracts on a long-term
18basis for the employment, assignment, or referral of nurses by
19a nurse agency to a health care facility, (ii) contracts on a
20long-term basis for the employment, assignment, or referral of
21certified nurse aides by a nurse agency to a health care
22facility, or (iii) invoices for contracts described in item
23(i) or (ii). However, a nurse agency that is exempt from the
24requirements of subparagraphs (2) and (3) of this subsection
25must submit the information described in items (i), (ii), and
26(iii) upon request by the Department pursuant to Section 14.1.

 

 

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1    (b) Each nurse agency shall have a nurse serving as a
2manager or supervisor of all nurses and certified nurses
3aides.
4    (c) Each nurse agency shall ensure that its employees meet
5the minimum licensing, training, continuing education, and
6orientation standards for which those employees are licensed
7or certified.
8    (d) A nurse agency shall not employ, assign, or refer for
9use in an Illinois health care facility a nurse or certified
10nurse aide unless certified or licensed under applicable
11provisions of State and federal law or regulations. Each
12certified nurse aide shall comply with all pertinent
13regulations of the Illinois Department of Public Health
14relating to the health and other qualifications of personnel
15employed in health care facilities.
16    (e) The Department may adopt rules to monitor the usage of
17nurse agency services to determine their impact.
18    (f) Nurse agencies are prohibited from recruiting
19potential employees on the premises of a health care facility
20or requiring, as a condition of employment, assignment, or
21referral, that their employees recruit new employees for the
22nurse agency from among the permanent employees of the health
23care facility to which the nurse agency employees have been
24employed, assigned, or referred, and the health care facility
25to which such employees are employed, assigned, or referred is
26prohibited from requiring, as a condition of employment, that

 

 

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1their employees recruit new employees from these nurse agency
2employees. Violation of this provision is a business offense.
3    (g) Nurse agencies are prohibited from entering into
4covenants not to compete with nurses and certified nurse aides
5if the nurse is employed, assigned, or referred by a nurse
6agency to a health care facility on a temporary basis or the
7certified nurse aide is employed, assigned, or referred by a
8nurse agency to a health care facility on a temporary basis. A
9covenant not to compete entered into on or after July 1, 2022
10(the effective date of Public Act 102-946) this amendatory Act
11of the 102nd General Assembly between a nurse agency and a
12nurse or a certified nurse aide is illegal and void if (i) the
13nurse is employed, assigned, or referred by a nurse agency to a
14health care facility on a temporary basis or (ii) the
15certified nurse aide is employed, assigned, or referred by a
16nurse agency to a health care facility on a temporary basis is
17illegal and void. The nurse nursing agency shall not, in any
18contract on a temporary basis with any nurse, certified nurse
19aide, employee or health care facility, require the payment of
20liquidated damages, conversion fees, employment fees, buy-out
21fees, placement fees, or other compensation if the nurse or
22certified nurse aide employee is hired as a permanent employee
23of the a health care facility. However, a nurse agency may, in
24a contract on a long-term basis with any nurse, certified
25nurse aide, or health care facility, require the payment of
26liquidated damages, conversion fees, employment fees, buy-out

 

 

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1fees, placement fees, or other compensation if the nurse or
2certified nurse aide is hired before the expiration of a
3covenant not to compete as a permanent employee of the health
4care facility.
5    (h) A nurse agency shall submit a report quarterly to the
6Department for each health care entity with whom the agency
7contracts that includes all of the following by provider type
8and county in which the work was performed:
9        (1) A list of the average amount charged to the health
10    care facility for each individual employee category.
11        (2) A list of the average amount paid by the agency to
12    employees in each individual employee category.
13        (3) A list of the average amount of labor-related
14    costs paid by the agency for each employee category,
15    including payroll taxes, workers' compensation insurance,
16    professional liability coverage, credentialing and
17    testing, and other employee related costs.
18    The Department shall publish by county in which the work
19was performed the average amount charged to the health care
20facilities by nurse agencies for each individual worker
21category and the average amount paid by the agency to each
22individual worker category. This subsection does not apply to
23a nurse or certified nurse aide if the nurse or certified nurse
24aide is employed, assigned, or referred by a nurse agency to a
25health care facility on a long-term basis. However, a nurse
26agency that is exempt from the requirements of this subsection

 

 

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1must submit the information required by this subsection upon
2request by the Department pursuant to Section 14.1.
3    (i) The Department shall publish on its website the
4reports yearly by county.
5    (j) The Department of Labor shall compel production of the
6maintained records, as required under this Section, by the
7nurse agencies.
8(Source: P.A. 102-946, eff. 7-1-22.)
 
9    (225 ILCS 510/14.3)
10    Sec. 14.3. Contracts between nurse agencies and health
11care facilities.
12    (a) A contract entered into on or after the effective date
13of this amendatory Act of the 102nd General Assembly between
14the nurse agency and health care facility must contain the
15following provisions:
16        (1) A full disclosure of charges and compensation. The
17    disclosure shall include a schedule of all hourly bill
18    rates per category of employee, a full description of
19    administrative charges, and a schedule of rates of all
20    compensation per category of employee, including, but not
21    limited to, hourly regular pay rate, shift differential,
22    weekend differential, hazard pay, charge nurse add-on,
23    overtime, holiday pay, and travel or mileage pay.
24        (2) A commitment that nurses or certified nurse aides
25    employed, assigned, or referred to a health care facility

 

 

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1    by the nurse agency perform any and all duties called for
2    within the full scope of practice for which the nurse or
3    certified nurse aide is licensed or certified.
4        (3) No less than 100% of the nurse or certified nurse
5    aide hourly rate shall be paid to the nurse or certified
6    nurse aide employee.
7    (b) A party's failure to comply with the requirements of
8subsection (a) shall be a defense to the enforcement of a
9contract between a nurse agency and a health care facility.
10Any health care facility or nurse agency aggrieved by a
11violation of subsection (a) shall have a right of action in a
12State court against the offending party. A prevailing party
13may recover for each violation:
14        (1) liquidated damages of $1,500 or actual damages,
15    whichever is greater;
16        (2) reasonable attorney's fees and costs, including
17    expert witness fees and other litigation expenses; and
18        (3) other relief, including an injunction, as the
19    court may deem appropriate.
20    (c) This Section does not apply to contracts on a
21long-term basis between a nurse agency and a health care
22facility providing for the employment, assignment, or referral
23of nurses or certified nurse aides to the health care
24facility. However, a nurse agency that is exempt from the
25requirements of this Section must submit the information
26required by this Section upon request by the Department

 

 

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1pursuant to Section 14.1.
2(Source: P.A. 102-946, eff. 7-1-22.)
 
3    Section 30. The Illinois Public Aid Code is amended by
4changing Sections 5-5.02, 5-5.2, 5-5.7b, and 5B-2 as follows:
 
5    (305 ILCS 5/5-5.02)  (from Ch. 23, par. 5-5.02)
6    Sec. 5-5.02. Hospital reimbursements.
7    (a) Reimbursement to hospitals; July 1, 1992 through
8September 30, 1992. Notwithstanding any other provisions of
9this Code or the Illinois Department's Rules promulgated under
10the Illinois Administrative Procedure Act, reimbursement to
11hospitals for services provided during the period July 1, 1992
12through September 30, 1992, shall be as follows:
13        (1) For inpatient hospital services rendered, or if
14    applicable, for inpatient hospital discharges occurring,
15    on or after July 1, 1992 and on or before September 30,
16    1992, the Illinois Department shall reimburse hospitals
17    for inpatient services under the reimbursement
18    methodologies in effect for each hospital, and at the
19    inpatient payment rate calculated for each hospital, as of
20    June 30, 1992. For purposes of this paragraph,
21    "reimbursement methodologies" means all reimbursement
22    methodologies that pertain to the provision of inpatient
23    hospital services, including, but not limited to, any
24    adjustments for disproportionate share, targeted access,

 

 

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1    critical care access and uncompensated care, as defined by
2    the Illinois Department on June 30, 1992.
3        (2) For the purpose of calculating the inpatient
4    payment rate for each hospital eligible to receive
5    quarterly adjustment payments for targeted access and
6    critical care, as defined by the Illinois Department on
7    June 30, 1992, the adjustment payment for the period July
8    1, 1992 through September 30, 1992, shall be 25% of the
9    annual adjustment payments calculated for each eligible
10    hospital, as of June 30, 1992. The Illinois Department
11    shall determine by rule the adjustment payments for
12    targeted access and critical care beginning October 1,
13    1992.
14        (3) For the purpose of calculating the inpatient
15    payment rate for each hospital eligible to receive
16    quarterly adjustment payments for uncompensated care, as
17    defined by the Illinois Department on June 30, 1992, the
18    adjustment payment for the period August 1, 1992 through
19    September 30, 1992, shall be one-sixth of the total
20    uncompensated care adjustment payments calculated for each
21    eligible hospital for the uncompensated care rate year, as
22    defined by the Illinois Department, ending on July 31,
23    1992. The Illinois Department shall determine by rule the
24    adjustment payments for uncompensated care beginning
25    October 1, 1992.
26    (b) Inpatient payments. For inpatient services provided on

 

 

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1or after October 1, 1993, in addition to rates paid for
2hospital inpatient services pursuant to the Illinois Health
3Finance Reform Act, as now or hereafter amended, or the
4Illinois Department's prospective reimbursement methodology,
5or any other methodology used by the Illinois Department for
6inpatient services, the Illinois Department shall make
7adjustment payments, in an amount calculated pursuant to the
8methodology described in paragraph (c) of this Section, to
9hospitals that the Illinois Department determines satisfy any
10one of the following requirements:
11        (1) Hospitals that are described in Section 1923 of
12    the federal Social Security Act, as now or hereafter
13    amended, except that for rate year 2015 and after a
14    hospital described in Section 1923(b)(1)(B) of the federal
15    Social Security Act and qualified for the payments
16    described in subsection (c) of this Section for rate year
17    2014 provided the hospital continues to meet the
18    description in Section 1923(b)(1)(B) in the current
19    determination year; or
20        (2) Illinois hospitals that have a Medicaid inpatient
21    utilization rate which is at least one-half a standard
22    deviation above the mean Medicaid inpatient utilization
23    rate for all hospitals in Illinois receiving Medicaid
24    payments from the Illinois Department; or
25        (3) Illinois hospitals that on July 1, 1991 had a
26    Medicaid inpatient utilization rate, as defined in

 

 

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1    paragraph (h) of this Section, that was at least the mean
2    Medicaid inpatient utilization rate for all hospitals in
3    Illinois receiving Medicaid payments from the Illinois
4    Department and which were located in a planning area with
5    one-third or fewer excess beds as determined by the Health
6    Facilities and Services Review Board, and that, as of June
7    30, 1992, were located in a federally designated Health
8    Manpower Shortage Area; or
9        (4) Illinois hospitals that:
10            (A) have a Medicaid inpatient utilization rate
11        that is at least equal to the mean Medicaid inpatient
12        utilization rate for all hospitals in Illinois
13        receiving Medicaid payments from the Department; and
14            (B) also have a Medicaid obstetrical inpatient
15        utilization rate that is at least one standard
16        deviation above the mean Medicaid obstetrical
17        inpatient utilization rate for all hospitals in
18        Illinois receiving Medicaid payments from the
19        Department for obstetrical services; or
20        (5) Any children's hospital, which means a hospital
21    devoted exclusively to caring for children. A hospital
22    which includes a facility devoted exclusively to caring
23    for children shall be considered a children's hospital to
24    the degree that the hospital's Medicaid care is provided
25    to children if either (i) the facility devoted exclusively
26    to caring for children is separately licensed as a

 

 

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1    hospital by a municipality prior to February 28, 2013;
2    (ii) the hospital has been designated by the State as a
3    Level III perinatal care facility, has a Medicaid
4    Inpatient Utilization rate greater than 55% for the rate
5    year 2003 disproportionate share determination, and has
6    more than 10,000 qualified children days as defined by the
7    Department in rulemaking; (iii) the hospital has been
8    designated as a Perinatal Level III center by the State as
9    of December 1, 2017, is a Pediatric Critical Care Center
10    designated by the State as of December 1, 2017 and has a
11    2017 Medicaid inpatient utilization rate equal to or
12    greater than 45%; or (iv) the hospital has been designated
13    as a Perinatal Level II center by the State as of December
14    1, 2017, has a 2017 Medicaid Inpatient Utilization Rate
15    greater than 70%, and has at least 10 pediatric beds as
16    listed on the IDPH 2015 calendar year hospital profile; or
17        (6) A hospital that reopens a previously closed
18    hospital facility within 4 calendar years of the hospital
19    facility's closure, if the previously closed hospital
20    facility qualified for payments under paragraph (c) at the
21    time of closure, until utilization data for the new
22    facility is available for the Medicaid inpatient
23    utilization rate calculation. For purposes of this clause,
24    a "closed hospital facility" shall include hospitals that
25    have been terminated from participation in the medical
26    assistance program in accordance with Section 12-4.25 of

 

 

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1    this Code.
2    (c) Inpatient adjustment payments. The adjustment payments
3required by paragraph (b) shall be calculated based upon the
4hospital's Medicaid inpatient utilization rate as follows:
5        (1) hospitals with a Medicaid inpatient utilization
6    rate below the mean shall receive a per day adjustment
7    payment equal to $25;
8        (2) hospitals with a Medicaid inpatient utilization
9    rate that is equal to or greater than the mean Medicaid
10    inpatient utilization rate but less than one standard
11    deviation above the mean Medicaid inpatient utilization
12    rate shall receive a per day adjustment payment equal to
13    the sum of $25 plus $1 for each one percent that the
14    hospital's Medicaid inpatient utilization rate exceeds the
15    mean Medicaid inpatient utilization rate;
16        (3) hospitals with a Medicaid inpatient utilization
17    rate that is equal to or greater than one standard
18    deviation above the mean Medicaid inpatient utilization
19    rate but less than 1.5 standard deviations above the mean
20    Medicaid inpatient utilization rate shall receive a per
21    day adjustment payment equal to the sum of $40 plus $7 for
22    each one percent that the hospital's Medicaid inpatient
23    utilization rate exceeds one standard deviation above the
24    mean Medicaid inpatient utilization rate;
25        (4) hospitals with a Medicaid inpatient utilization
26    rate that is equal to or greater than 1.5 standard

 

 

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1    deviations above the mean Medicaid inpatient utilization
2    rate shall receive a per day adjustment payment equal to
3    the sum of $90 plus $2 for each one percent that the
4    hospital's Medicaid inpatient utilization rate exceeds 1.5
5    standard deviations above the mean Medicaid inpatient
6    utilization rate; and
7        (5) hospitals qualifying under clause (6) of paragraph
8    (b) shall have the rate assigned to the previously closed
9    hospital facility at the date of closure, until
10    utilization data for the new facility is available for the
11    Medicaid inpatient utilization rate calculation.
12    (c-1) Effective October 1, 2023, for rate year 2024 and
13thereafter, the Medicaid Inpatient utilization rate, as
14defined in paragraph (1) of subsection (h) and used in the
15determination of eligibility for payments under paragraph (c),
16shall be modified to exclude from both the numerator and
17denominator all days of care provided to military recruits or
18trainees for the United States Navy and covered by TriCare or
19its successor.
20    (d) Supplemental adjustment payments. In addition to the
21adjustment payments described in paragraph (c), hospitals as
22defined in clauses (1) through (6) of paragraph (b), excluding
23county hospitals (as defined in subsection (c) of Section 15-1
24of this Code) and a hospital organized under the University of
25Illinois Hospital Act, shall be paid supplemental inpatient
26adjustment payments of $60 per day. For purposes of Title XIX

 

 

10200HB4846sam002- 28 -LRB102 25362 AMQ 41943 a

1of the federal Social Security Act, these supplemental
2adjustment payments shall not be classified as adjustment
3payments to disproportionate share hospitals.
4    (e) The inpatient adjustment payments described in
5paragraphs (c) and (d) shall be increased on October 1, 1993
6and annually thereafter by a percentage equal to the lesser of
7(i) the increase in the DRI hospital cost index for the most
8recent 12-month 12 month period for which data are available,
9or (ii) the percentage increase in the statewide average
10hospital payment rate over the previous year's statewide
11average hospital payment rate. The sum of the inpatient
12adjustment payments under paragraphs (c) and (d) to a
13hospital, other than a county hospital (as defined in
14subsection (c) of Section 15-1 of this Code) or a hospital
15organized under the University of Illinois Hospital Act,
16however, shall not exceed $275 per day; that limit shall be
17increased on October 1, 1993 and annually thereafter by a
18percentage equal to the lesser of (i) the increase in the DRI
19hospital cost index for the most recent 12-month period for
20which data are available or (ii) the percentage increase in
21the statewide average hospital payment rate over the previous
22year's statewide average hospital payment rate.
23    (f) Children's hospital inpatient adjustment payments. For
24children's hospitals, as defined in clause (5) of paragraph
25(b), the adjustment payments required pursuant to paragraphs
26(c) and (d) shall be multiplied by 2.0.

 

 

10200HB4846sam002- 29 -LRB102 25362 AMQ 41943 a

1    (g) County hospital inpatient adjustment payments. For
2county hospitals, as defined in subsection (c) of Section 15-1
3of this Code, there shall be an adjustment payment as
4determined by rules issued by the Illinois Department.
5    (h) For the purposes of this Section the following terms
6shall be defined as follows:
7        (1) "Medicaid inpatient utilization rate" means a
8    fraction, the numerator of which is the number of a
9    hospital's inpatient days provided in a given 12-month
10    period to patients who, for such days, were eligible for
11    Medicaid under Title XIX of the federal Social Security
12    Act, and the denominator of which is the total number of
13    the hospital's inpatient days in that same period.
14        (2) "Mean Medicaid inpatient utilization rate" means
15    the total number of Medicaid inpatient days provided by
16    all Illinois Medicaid-participating hospitals divided by
17    the total number of inpatient days provided by those same
18    hospitals.
19        (3) "Medicaid obstetrical inpatient utilization rate"
20    means the ratio of Medicaid obstetrical inpatient days to
21    total Medicaid inpatient days for all Illinois hospitals
22    receiving Medicaid payments from the Illinois Department.
23    (i) Inpatient adjustment payment limit. In order to meet
24the limits of Public Law 102-234 and Public Law 103-66, the
25Illinois Department shall by rule adjust disproportionate
26share adjustment payments.

 

 

10200HB4846sam002- 30 -LRB102 25362 AMQ 41943 a

1    (j) University of Illinois Hospital inpatient adjustment
2payments. For hospitals organized under the University of
3Illinois Hospital Act, there shall be an adjustment payment as
4determined by rules adopted by the Illinois Department.
5    (k) The Illinois Department may by rule establish criteria
6for and develop methodologies for adjustment payments to
7hospitals participating under this Article.
8    (l) On and after July 1, 2012, the Department shall reduce
9any rate of reimbursement for services or other payments or
10alter any methodologies authorized by this Code to reduce any
11rate of reimbursement for services or other payments in
12accordance with Section 5-5e.
13    (m) The Department shall establish a cost-based
14reimbursement methodology for determining payments to
15hospitals for approved graduate medical education (GME)
16programs for dates of service on and after July 1, 2018.
17        (1) As used in this subsection, "hospitals" means the
18    University of Illinois Hospital as defined in the
19    University of Illinois Hospital Act and a county hospital
20    in a county of over 3,000,000 inhabitants.
21        (2) An amendment to the Illinois Title XIX State Plan
22    defining GME shall maximize reimbursement, shall not be
23    limited to the education programs or special patient care
24    payments allowed under Medicare, and shall include:
25            (A) inpatient days;
26            (B) outpatient days;

 

 

10200HB4846sam002- 31 -LRB102 25362 AMQ 41943 a

1            (C) direct costs;
2            (D) indirect costs;
3            (E) managed care days;
4            (F) all stages of medical training and education
5        including students, interns, residents, and fellows
6        with no caps on the number of persons who may qualify;
7        and
8            (G) patient care payments related to the
9        complexities of treating Medicaid enrollees including
10        clinical and social determinants of health.
11        (3) The Department shall make all GME payments
12    directly to hospitals including such costs in support of
13    clients enrolled in Medicaid managed care entities.
14        (4) The Department shall promptly take all actions
15    necessary for reimbursement to be effective for dates of
16    service on and after July 1, 2018 including publishing all
17    appropriate public notices, amendments to the Illinois
18    Title XIX State Plan, and adoption of administrative rules
19    if necessary.
20        (5) As used in this subsection, "managed care days"
21    means costs associated with services rendered to enrollees
22    of Medicaid managed care entities. "Medicaid managed care
23    entities" means any entity which contracts with the
24    Department to provide services paid for on a capitated
25    basis. "Medicaid managed care entities" includes a managed
26    care organization and a managed care community network.

 

 

10200HB4846sam002- 32 -LRB102 25362 AMQ 41943 a

1        (6) All payments under this Section are contingent
2    upon federal approval of changes to the Illinois Title XIX
3    State Plan, if that approval is required.
4        (7) The Department may adopt rules necessary to
5    implement Public Act 100-581 through the use of emergency
6    rulemaking in accordance with subsection (aa) of Section
7    5-45 of the Illinois Administrative Procedure Act. For
8    purposes of that Act, the General Assembly finds that the
9    adoption of rules to implement Public Act 100-581 is
10    deemed an emergency and necessary for the public interest,
11    safety, and welfare.
12(Source: P.A. 101-81, eff. 7-12-19; 102-682, eff. 12-10-21;
13102-886, eff. 5-17-22.)
 
14    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
15    Sec. 5-5.2. Payment.
16    (a) All nursing facilities that are grouped pursuant to
17Section 5-5.1 of this Act shall receive the same rate of
18payment for similar services.
19    (b) It shall be a matter of State policy that the Illinois
20Department shall utilize a uniform billing cycle throughout
21the State for the long-term care providers.
22    (c) (Blank).
23    (c-1) Notwithstanding any other provisions of this Code,
24the methodologies for reimbursement of nursing services as
25provided under this Article shall no longer be applicable for

 

 

10200HB4846sam002- 33 -LRB102 25362 AMQ 41943 a

1bills payable for nursing services rendered on or after a new
2reimbursement system based on the Patient Driven Payment Model
3(PDPM) has been fully operationalized, which shall take effect
4for services provided on or after the implementation of the
5PDPM reimbursement system begins. For the purposes of this
6amendatory Act of the 102nd General Assembly, the
7implementation date of the PDPM reimbursement system and all
8related provisions shall be July 1, 2022 if the following
9conditions are met: (i) the Centers for Medicare and Medicaid
10Services has approved corresponding changes in the
11reimbursement system and bed assessment; and (ii) the
12Department has filed rules to implement these changes no later
13than June 1, 2022. Failure of the Department to file rules to
14implement the changes provided in this amendatory Act of the
15102nd General Assembly no later than June 1, 2022 shall result
16in the implementation date being delayed to October 1, 2022.
17    (d) The new nursing services reimbursement methodology
18utilizing the Patient Driven Payment Model, which shall be
19referred to as the PDPM reimbursement system, taking effect
20July 1, 2022, upon federal approval by the Centers for
21Medicare and Medicaid Services, shall be based on the
22following:
23        (1) The methodology shall be resident-centered,
24    facility-specific, cost-based, and based on guidance from
25    the Centers for Medicare and Medicaid Services.
26        (2) Costs shall be annually rebased and case mix index

 

 

10200HB4846sam002- 34 -LRB102 25362 AMQ 41943 a

1    quarterly updated. The nursing services methodology will
2    be assigned to the Medicaid enrolled residents on record
3    as of 30 days prior to the beginning of the rate period in
4    the Department's Medicaid Management Information System
5    (MMIS) as present on the last day of the second quarter
6    preceding the rate period based upon the Assessment
7    Reference Date of the Minimum Data Set (MDS).
8        (3) Regional wage adjustors based on the Health
9    Service Areas (HSA) groupings and adjusters in effect on
10    April 30, 2012 shall be included, except no adjuster shall
11    be lower than 1.06.
12        (4) PDPM nursing case mix indices in effect on March
13    1, 2022 shall be assigned to each resident class at no less
14    than 0.7858 of the Centers for Medicare and Medicaid
15    Services PDPM unadjusted case mix values, in effect on
16    March 1, 2022, utilizing an index maximization approach.
17        (5) The pool of funds available for distribution by
18    case mix and the base facility rate shall be determined
19    using the formula contained in subsection (d-1).
20        (6) The Department shall establish a variable per diem
21    staffing add-on in accordance with the most recent
22    available federal staffing report, currently the Payroll
23    Based Journal, for the same period of time, and if
24    applicable adjusted for acuity using the same quarter's
25    MDS. The Department shall rely on Payroll Based Journals
26    provided to the Department of Public Health to make a

 

 

10200HB4846sam002- 35 -LRB102 25362 AMQ 41943 a

1    determination of non-submission. If the Department is
2    notified by a facility of missing or inaccurate Payroll
3    Based Journal data or an incorrect calculation of
4    staffing, the Department must make a correction as soon as
5    the error is verified for the applicable quarter.
6        Facilities with at least 70% of the staffing indicated
7    by the STRIVE study shall be paid a per diem add-on of $9,
8    increasing by equivalent steps for each whole percentage
9    point until the facilities reach a per diem of $14.88.
10    Facilities with at least 80% of the staffing indicated by
11    the STRIVE study shall be paid a per diem add-on of $14.88,
12    increasing by equivalent steps for each whole percentage
13    point until the facilities reach a per diem add-on of
14    $23.80. Facilities with at least 92% of the staffing
15    indicated by the STRIVE study shall be paid a per diem
16    add-on of $23.80, increasing by equivalent steps for each
17    whole percentage point until the facilities reach a per
18    diem add-on of $29.75. Facilities with at least 100% of
19    the staffing indicated by the STRIVE study shall be paid a
20    per diem add-on of $29.75, increasing by equivalent steps
21    for each whole percentage point until the facilities reach
22    a per diem add-on of $35.70. Facilities with at least 110%
23    of the staffing indicated by the STRIVE study shall be
24    paid a per diem add-on of $35.70, increasing by equivalent
25    steps for each whole percentage point until the facilities
26    reach a per diem add-on of $38.68. Facilities with at

 

 

10200HB4846sam002- 36 -LRB102 25362 AMQ 41943 a

1    least 125% or higher of the staffing indicated by the
2    STRIVE study shall be paid a per diem add-on of $38.68.
3    Beginning April 1, 2023, no nursing facility's variable
4    staffing per diem add-on shall be reduced by more than 5%
5    in 2 consecutive quarters. For the quarters beginning July
6    1, 2022 and October 1, 2022, no facility's variable per
7    diem staffing add-on shall be calculated at a rate lower
8    than 85% of the staffing indicated by the STRIVE study. No
9    facility below 70% of the staffing indicated by the STRIVE
10    study shall receive a variable per diem staffing add-on
11    after December 31, 2022.
12        (7) For dates of services beginning July 1, 2022, the
13    PDPM nursing component per diem for each nursing facility
14    shall be the product of the facility's (i) statewide PDPM
15    nursing base per diem rate, $92.25, adjusted for the
16    facility average PDPM case mix index calculated quarterly
17    and (ii) the regional wage adjuster, and then add the
18    Medicaid access adjustment as defined in (e-3) of this
19    Section. Transition rates for services provided between
20    July 1, 2022 and October 1, 2023 shall be the greater of
21    the PDPM nursing component per diem or:
22            (A) for the quarter beginning July 1, 2022, the
23        RUG-IV nursing component per diem;
24            (B) for the quarter beginning October 1, 2022, the
25        sum of the RUG-IV nursing component per diem
26        multiplied by 0.80 and the PDPM nursing component per

 

 

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1        diem multiplied by 0.20;
2            (C) for the quarter beginning January 1, 2023, the
3        sum of the RUG-IV nursing component per diem
4        multiplied by 0.60 and the PDPM nursing component per
5        diem multiplied by 0.40;
6            (D) for the quarter beginning April 1, 2023, the
7        sum of the RUG-IV nursing component per diem
8        multiplied by 0.40 and the PDPM nursing component per
9        diem multiplied by 0.60;
10            (E) for the quarter beginning July 1, 2023, the
11        sum of the RUG-IV nursing component per diem
12        multiplied by 0.20 and the PDPM nursing component per
13        diem multiplied by 0.80; or
14            (F) for the quarter beginning October 1, 2023 and
15        each subsequent quarter, the transition rate shall end
16        and a nursing facility shall be paid 100% of the PDPM
17        nursing component per diem.
18    (d-1) Calculation of base year Statewide RUG-IV nursing
19base per diem rate.
20        (1) Base rate spending pool shall be:
21            (A) The base year resident days which are
22        calculated by multiplying the number of Medicaid
23        residents in each nursing home as indicated in the MDS
24        data defined in paragraph (4) by 365.
25            (B) Each facility's nursing component per diem in
26        effect on July 1, 2012 shall be multiplied by

 

 

10200HB4846sam002- 38 -LRB102 25362 AMQ 41943 a

1        subsection (A).
2            (C) Thirteen million is added to the product of
3        subparagraph (A) and subparagraph (B) to adjust for
4        the exclusion of nursing homes defined in paragraph
5        (5).
6        (2) For each nursing home with Medicaid residents as
7    indicated by the MDS data defined in paragraph (4),
8    weighted days adjusted for case mix and regional wage
9    adjustment shall be calculated. For each home this
10    calculation is the product of:
11            (A) Base year resident days as calculated in
12        subparagraph (A) of paragraph (1).
13            (B) The nursing home's regional wage adjustor
14        based on the Health Service Areas (HSA) groupings and
15        adjustors in effect on April 30, 2012.
16            (C) Facility weighted case mix which is the number
17        of Medicaid residents as indicated by the MDS data
18        defined in paragraph (4) multiplied by the associated
19        case weight for the RUG-IV 48 grouper model using
20        standard RUG-IV procedures for index maximization.
21            (D) The sum of the products calculated for each
22        nursing home in subparagraphs (A) through (C) above
23        shall be the base year case mix, rate adjusted
24        weighted days.
25        (3) The Statewide RUG-IV nursing base per diem rate:
26            (A) on January 1, 2014 shall be the quotient of the

 

 

10200HB4846sam002- 39 -LRB102 25362 AMQ 41943 a

1        paragraph (1) divided by the sum calculated under
2        subparagraph (D) of paragraph (2);
3            (B) on and after July 1, 2014 and until July 1,
4        2022, shall be the amount calculated under
5        subparagraph (A) of this paragraph (3) plus $1.76; and
6            (C) beginning July 1, 2022 and thereafter, $7
7        shall be added to the amount calculated under
8        subparagraph (B) of this paragraph (3) of this
9        Section.
10        (4) Minimum Data Set (MDS) comprehensive assessments
11    for Medicaid residents on the last day of the quarter used
12    to establish the base rate.
13        (5) Nursing facilities designated as of July 1, 2012
14    by the Department as "Institutions for Mental Disease"
15    shall be excluded from all calculations under this
16    subsection. The data from these facilities shall not be
17    used in the computations described in paragraphs (1)
18    through (4) above to establish the base rate.
19    (e) Beginning July 1, 2014, the Department shall allocate
20funding in the amount up to $10,000,000 for per diem add-ons to
21the RUGS methodology for dates of service on and after July 1,
222014:
23        (1) $0.63 for each resident who scores in I4200
24    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
25        (2) $2.67 for each resident who scores either a "1" or
26    "2" in any items S1200A through S1200I and also scores in

 

 

10200HB4846sam002- 40 -LRB102 25362 AMQ 41943 a

1    RUG groups PA1, PA2, BA1, or BA2 until September 30, 2023,
2    or for each resident who scores a "1" or "2" in PDPM groups
3    PA1, PA2, BAB1, or BAB2 beginning July 1, 2022 and
4    thereafter.
5    (e-1) (Blank).
6    (e-2) For dates of services beginning January 1, 2014 and
7ending September 30, 2023, the RUG-IV nursing component per
8diem for a nursing home shall be the product of the statewide
9RUG-IV nursing base per diem rate, the facility average case
10mix index, and the regional wage adjustor.
11    (e-3) A Medicaid Access Adjustment of $4 adjusted for the
12facility average PDPM case mix index calculated quarterly
13shall be added to the statewide PDPM nursing per diem for all
14facilities with annual Medicaid bed days of at least 70% of all
15occupied bed days adjusted quarterly. For each new calendar
16year and for the 6-month period beginning July 1, 2022, the
17percentage of a facility's occupied bed days comprised of
18Medicaid bed days shall be determined by the Department
19quarterly. Beginning on the effective date of this amendatory
20Act of the 102nd General Assembly, the Medicaid Access
21Adjustment of $4 shall be increased by $0.75 and the increased
22reimbursement rate shall be applied to services rendered on
23and after July 1, 2022. The Department shall recalculate each
24affected facility's reimbursement rate retroactive to July 1,
252022 and remit all additional money owed to each facility as a
26result of the retroactive recalculation. This subsection shall

 

 

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1be inoperative on and after January 1, 2028.
2    (f) (Blank).
3    (g) Notwithstanding any other provision of this Code, on
4and after July 1, 2012, for facilities not designated by the
5Department of Healthcare and Family Services as "Institutions
6for Mental Disease", rates effective May 1, 2011 shall be
7adjusted as follows:
8        (1) (Blank);
9        (2) (Blank);
10        (3) Facility rates for the capital and support
11    components shall be reduced by 1.7%.
12    (h) Notwithstanding any other provision of this Code, on
13and after July 1, 2012, nursing facilities designated by the
14Department of Healthcare and Family Services as "Institutions
15for Mental Disease" and "Institutions for Mental Disease" that
16are facilities licensed under the Specialized Mental Health
17Rehabilitation Act of 2013 shall have the nursing,
18socio-developmental, capital, and support components of their
19reimbursement rate effective May 1, 2011 reduced in total by
202.7%.
21    (i) On and after July 1, 2014, the reimbursement rates for
22the support component of the nursing facility rate for
23facilities licensed under the Nursing Home Care Act as skilled
24or intermediate care facilities shall be the rate in effect on
25June 30, 2014 increased by 8.17%.
26    (j) Notwithstanding any other provision of law, subject to

 

 

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1federal approval, effective July 1, 2019, sufficient funds
2shall be allocated for changes to rates for facilities
3licensed under the Nursing Home Care Act as skilled nursing
4facilities or intermediate care facilities for dates of
5services on and after July 1, 2019: (i) to establish, through
6June 30, 2022 a per diem add-on to the direct care per diem
7rate not to exceed $70,000,000 annually in the aggregate
8taking into account federal matching funds for the purpose of
9addressing the facility's unique staffing needs, adjusted
10quarterly and distributed by a weighted formula based on
11Medicaid bed days on the last day of the second quarter
12preceding the quarter for which the rate is being adjusted.
13Beginning July 1, 2022, the annual $70,000,000 described in
14the preceding sentence shall be dedicated to the variable per
15diem add-on for staffing under paragraph (6) of subsection
16(d); and (ii) in an amount not to exceed $170,000,000 annually
17in the aggregate taking into account federal matching funds to
18permit the support component of the nursing facility rate to
19be updated as follows:
20        (1) 80%, or $136,000,000, of the funds shall be used
21    to update each facility's rate in effect on June 30, 2019
22    using the most recent cost reports on file, which have had
23    a limited review conducted by the Department of Healthcare
24    and Family Services and will not hold up enacting the rate
25    increase, with the Department of Healthcare and Family
26    Services.

 

 

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1        (2) After completing the calculation in paragraph (1),
2    any facility whose rate is less than the rate in effect on
3    June 30, 2019 shall have its rate restored to the rate in
4    effect on June 30, 2019 from the 20% of the funds set
5    aside.
6        (3) The remainder of the 20%, or $34,000,000, shall be
7    used to increase each facility's rate by an equal
8    percentage.
9    (k) During the first quarter of State Fiscal Year 2020,
10the Department of Healthcare of Family Services must convene a
11technical advisory group consisting of members of all trade
12associations representing Illinois skilled nursing providers
13to discuss changes necessary with federal implementation of
14Medicare's Patient-Driven Payment Model. Implementation of
15Medicare's Patient-Driven Payment Model shall, by September 1,
162020, end the collection of the MDS data that is necessary to
17maintain the current RUG-IV Medicaid payment methodology. The
18technical advisory group must consider a revised reimbursement
19methodology that takes into account transparency,
20accountability, actual staffing as reported under the
21federally required Payroll Based Journal system, changes to
22the minimum wage, adequacy in coverage of the cost of care, and
23a quality component that rewards quality improvements.
24    (l) The Department shall establish per diem add-on
25payments to improve the quality of care delivered by
26facilities, including:

 

 

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1        (1) Incentive payments determined by facility
2    performance on specified quality measures in an initial
3    amount of $70,000,000. Nothing in this subsection shall be
4    construed to limit the quality of care payments in the
5    aggregate statewide to $70,000,000, and, if quality of
6    care has improved across nursing facilities, the
7    Department shall adjust those add-on payments accordingly.
8    The quality payment methodology described in this
9    subsection must be used for at least State Fiscal Year
10    2023. Beginning with the quarter starting July 1, 2023,
11    the Department may add, remove, or change quality metrics
12    and make associated changes to the quality payment
13    methodology as outlined in subparagraph (E). Facilities
14    designated by the Centers for Medicare and Medicaid
15    Services as a special focus facility or a hospital-based
16    nursing home do not qualify for quality payments.
17            (A) Each quality pool must be distributed by
18        assigning a quality weighted score for each nursing
19        home which is calculated by multiplying the nursing
20        home's quality base period Medicaid days by the
21        nursing home's star rating weight in that period.
22            (B) Star rating weights are assigned based on the
23        nursing home's star rating for the LTS quality star
24        rating. As used in this subparagraph, "LTS quality
25        star rating" means the long-term stay quality rating
26        for each nursing facility, as assigned by the Centers

 

 

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1        for Medicare and Medicaid Services under the Five-Star
2        Quality Rating System. The rating is a number ranging
3        from 0 (lowest) to 5 (highest).
4                (i) Zero-star or one-star rating has a weight
5            of 0.
6                (ii) Two-star rating has a weight of 0.75.
7                (iii) Three-star rating has a weight of 1.5.
8                (iv) Four-star rating has a weight of 2.5.
9                (v) Five-star rating has a weight of 3.5.
10            (C) Each nursing home's quality weight score is
11        divided by the sum of all quality weight scores for
12        qualifying nursing homes to determine the proportion
13        of the quality pool to be paid to the nursing home.
14            (D) The quality pool is no less than $70,000,000
15        annually or $17,500,000 per quarter. The Department
16        shall publish on its website the estimated payments
17        and the associated weights for each facility 45 days
18        prior to when the initial payments for the quarter are
19        to be paid. The Department shall assign each facility
20        the most recent and applicable quarter's STAR value
21        unless the facility notifies the Department within 15
22        days of an issue and the facility provides reasonable
23        evidence demonstrating its timely compliance with
24        federal data submission requirements for the quarter
25        of record. If such evidence cannot be provided to the
26        Department, the STAR rating assigned to the facility

 

 

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1        shall be reduced by one from the prior quarter.
2            (E) The Department shall review quality metrics
3        used for payment of the quality pool and make
4        recommendations for any associated changes to the
5        methodology for distributing quality pool payments in
6        consultation with associations representing long-term
7        care providers, consumer advocates, organizations
8        representing workers of long-term care facilities, and
9        payors. The Department may establish, by rule, changes
10        to the methodology for distributing quality pool
11        payments.
12            (F) The Department shall disburse quality pool
13        payments from the Long-Term Care Provider Fund on a
14        monthly basis in amounts proportional to the total
15        quality pool payment determined for the quarter.
16            (G) The Department shall publish any changes in
17        the methodology for distributing quality pool payments
18        prior to the beginning of the measurement period or
19        quality base period for any metric added to the
20        distribution's methodology.
21        (2) Payments based on CNA tenure, promotion, and CNA
22    training for the purpose of increasing CNA compensation.
23    It is the intent of this subsection that payments made in
24    accordance with this paragraph be directly incorporated
25    into increased compensation for CNAs. As used in this
26    paragraph, "CNA" means a certified nursing assistant as

 

 

10200HB4846sam002- 47 -LRB102 25362 AMQ 41943 a

1    that term is described in Section 3-206 of the Nursing
2    Home Care Act, Section 3-206 of the ID/DD Community Care
3    Act, and Section 3-206 of the MC/DD Act. The Department
4    shall establish, by rule, payments to nursing facilities
5    equal to Medicaid's share of the tenure wage increments
6    specified in this paragraph for all reported CNA employee
7    hours compensated according to a posted schedule
8    consisting of increments at least as large as those
9    specified in this paragraph. The increments are as
10    follows: an additional $1.50 per hour for CNAs with at
11    least one and less than 2 years' experience plus another
12    $1 per hour for each additional year of experience up to a
13    maximum of $6.50 for CNAs with at least 6 years of
14    experience. For purposes of this paragraph, Medicaid's
15    share shall be the ratio determined by paid Medicaid bed
16    days divided by total bed days for the applicable time
17    period used in the calculation. In addition, and additive
18    to any tenure increments paid as specified in this
19    paragraph, the Department shall establish, by rule,
20    payments supporting Medicaid's share of the
21    promotion-based wage increments for CNA employee hours
22    compensated for that promotion with at least a $1.50
23    hourly increase. Medicaid's share shall be established as
24    it is for the tenure increments described in this
25    paragraph. Qualifying promotions shall be defined by the
26    Department in rules for an expected 10-15% subset of CNAs

 

 

10200HB4846sam002- 48 -LRB102 25362 AMQ 41943 a

1    assigned intermediate, specialized, or added roles such as
2    CNA trainers, CNA scheduling "captains", and CNA
3    specialists for resident conditions like dementia or
4    memory care or behavioral health.
5    (m) The Department shall work with nursing facility
6industry representatives to design policies and procedures to
7permit facilities to address the integrity of data from
8federal reporting sites used by the Department in setting
9facility rates.
10(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
11102-77, eff. 7-9-21; 102-558, eff. 8-20-21; 102-1035, eff.
125-31-22.)
 
13    (305 ILCS 5/5-5.7b)
14    Sec. 5-5.7b. Pandemic related stability payments to
15ambulance service providers in response to COVID-19.
16    (a) Definitions. As used in this Section:
17    "Ambulance Services Industry" means the industry that is
18comprised of "Qualifying Ground Ambulance Service Providers",
19as defined in this Section.
20    "Qualifying Ground Ambulance Service Provider" means a
21"vehicle service provider," as that term is defined in Section
223.85 of the Emergency Medical Services (EMS) Systems Act,
23which operates licensed ambulances for the purpose of
24providing emergency, non-emergency ambulance services, or both
25emergency and non-emergency ambulance services. The term

 

 

10200HB4846sam002- 49 -LRB102 25362 AMQ 41943 a

1"Qualifying Ground Ambulance Service Provider" is limited to
2ambulance and EMS agencies that are privately held and
3nonprofit organizations headquartered within the State and
4licensed by the Department of Public Health as of March 12,
52020.
6    "Eligible worker" means a staff member of a Qualifying
7Ground Ambulance Service Provider engaged in "essential work",
8as defined by Section 9901 of the ARPA and related federal
9guidance, and (1) whose total pay is below 150% of the average
10annual wage for all occupations in the worker's county of
11residence, as defined by the BLS Occupational Employment and
12Wage Statistics or (2) is not exempt from the federal Fair
13Labor Standards Act overtime provisions.
14    (b) Purpose. The Department may receive federal funds
15under the authority of legislation passed in response to the
16Coronavirus epidemic, including, but not limited to, the
17American Rescue Plan Act of 2021, P.L. 117-2 (the "ARPA").
18Upon receipt or availability of such State or federal funds,
19and subject to appropriations for their use, the Department
20shall establish and administer programs for purposes allowable
21under Section 9901 of the ARPA to provide financial assistance
22to Qualifying Ground Ambulance Service Providers for premium
23pay for eligible workers, to provide reimbursement for
24eligible expenditures, and to provide support following the
25negative economic impact of the COVID-19 public health
26emergency on the Ambulance Services Industry. Financial

 

 

10200HB4846sam002- 50 -LRB102 25362 AMQ 41943 a

1assistance may include, but is not limited to, grants, expense
2reimbursements, or subsidies.
3    (b-1) By December 31, 2022, the Department shall obtain
4appropriate documentation from Qualifying Ground Ambulance
5Service Providers to ascertain an accurate count of the number
6of licensed vehicles available to serve enrollees in the
7State's Medical Assistance Programs, which shall be known as
8the "total eligible vehicles". By February 28, 2023,
9Qualifying Ground Ambulance Service Providers shall be
10initially notified of their eligible award, which shall be the
11product of (i) the total amount of funds allocated under this
12Section and (ii) a quotient, the numerator of which is the
13number of licensed ground ambulance vehicles of an individual
14Qualifying Ground Ambulance Service Provider and the
15denominator of which is the total eligible vehicles. After
16March 31, 2024, any unobligated funds shall be reallocated pro
17rata to the remaining Qualifying Ground Ambulance Service
18Providers that are able to prove up eligible expenses in
19excess of their initial award amount until all such
20appropriated funds are exhausted.
21    Providers shall indicate to the Department what portion of
22their award they wish to allocate under the purposes outlined
23under paragraphs (d), (e), or (f), if applicable, of this
24Section.
25    (c) Non-Emergency Service Certification. To be eligible
26for funding under this Section, a Qualifying Ground Ambulance

 

 

10200HB4846sam002- 51 -LRB102 25362 AMQ 41943 a

1Service Provider that provides non-emergency services to
2institutional residents must certify whether or not it is able
3to that it will provide non-emergency ambulance services to
4individuals enrolled in the State's Medical Assistance Program
5and residing in non-institutional settings for at least one
6year following the receipt of funding pursuant to this
7amendatory Act of the 102nd General Assembly. Certification
8indicating that a provider has such an ability does not mean
9that a provider is required to accept any or all requested
10transports. The provider shall maintain the certification in
11its records. The provider shall also maintain documentation of
12all non-emergency ambulance services for the period covered by
13the certification. The provider shall produce the
14certification and supporting documentation upon demand by the
15Department or its representative. Failure to comply shall
16result in recovery of any payments made by the Department.
17    (d) Premium Pay Initiative. Subject to paragraph (c) of
18this Section, the Department shall establish a Premium Pay
19Initiative to distribute awards to each Qualifying Ground
20Ambulance Service Provider for the purpose of providing
21premium pay to eligible workers.
22        (1) Financial assistance pursuant to this paragraph
23    (d) shall be scaled based on a process determined by the
24    Department. The amount awarded to each Qualifying Ground
25    Ambulance Service Provider shall be up to $13 per hour for
26    each eligible worker employed.

 

 

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1        (2) The financial assistance awarded shall only be
2    expended for premium pay for eligible workers, which must
3    be in addition to any wages or remuneration the eligible
4    worker has already received and shall be subject to the
5    other requirements and limitations set forth in the ARPA
6    and related federal guidance.
7        (3) Upon receipt of funds, the Qualifying Ground
8    Ambulance Service Provider shall distribute funds such
9    that an eligible worker receives an amount up to $13 per
10    hour but no more than $25,000 for the duration of the
11    program. The Qualifying Ground Ambulance Service Provider
12    shall provide a written certification to the Department
13    acknowledging compliance with this paragraph (d).
14        (4) No portion of these funds shall be spent on
15    volunteer staff.
16        (5) These funds shall not be used to make retroactive
17    premium payments prior to the effective date of this
18    amendatory Act of the 102nd General Assembly.
19        (6) The Department shall require each Qualifying
20    Ground Ambulance Service Provider that receives funds
21    under this paragraph (d) to submit appropriate
22    documentation acknowledging compliance with State and
23    federal law on an annual basis.
24    (e) COVID-19 Response Support Initiative. Subject to
25paragraph (c) of this Section and based on an application
26filed by a Qualifying Ground Ambulance Service Provider, the

 

 

10200HB4846sam002- 53 -LRB102 25362 AMQ 41943 a

1Department shall establish the Ground Ambulance COVID-19
2Response Support Initiative. The purpose of the award shall be
3to reimburse Qualifying Ground Ambulance Service Providers for
4eligible expenses under Section 9901 of the ARPA related to
5the public health impacts of the COVID-19 public health
6emergency, including, but not limited to: (i) costs incurred
7due to the COVID-19 public health emergency; (ii) costs
8related to vaccination programs, including vaccine incentives;
9(iii) costs related to COVID-19 testing; (iv) costs related to
10COVID-19 prevention and treatment equipment; (v) expenses for
11medical supplies; (vi) expenses for personal protective
12equipment; (vii) costs related to isolation and quarantine;
13(viii) costs for ventilation system installation and
14improvement; (ix) costs related to other emergency response
15equipment, such as ground ambulances, ventilators, cardiac
16monitoring equipment, defibrillation equipment, pacing
17equipment, ambulance stretchers, and radio equipment; and (x)
18other emergency medical response expenses. costs related to
19COVID-19 testing for patients, COVID-19 prevention and
20treatment equipment, medical supplies, personal protective
21equipment, and other emergency medical response treatments.
22        (1) The award shall be for eligible obligated
23    expenditures incurred no earlier than May 1, 2022 and no
24    later than June 30, 2024 2023. Expenditures under this
25    paragraph must be incurred by June 30, 2025.
26        (2) Funds awarded under this paragraph (e) shall not

 

 

10200HB4846sam002- 54 -LRB102 25362 AMQ 41943 a

1    be expended for premium pay to eligible workers.
2        (3) The Department shall require each Qualifying
3    Ground Ambulance Service Provider that receives funds
4    under this paragraph (e) to submit appropriate
5    documentation acknowledging compliance with State and
6    federal law on an annual basis. For purchases of medical
7    equipment or other capital expenditures, the Qualifying
8    Ground Ambulance Service Provider shall include
9    documentation that describes the harm or need to be
10    addressed by the expenditures and how that capital
11    expenditure is appropriate to address that identified harm
12    or need.
13    (f) Ambulance Industry Recovery Program. If the Department
14designates the Ambulance Services Industry as an "impacted
15industry", as defined by the ARPA and related federal
16guidance, the Department shall establish the Ambulance
17Industry Recovery Grant Program, to provide aid to Qualifying
18Ground Ambulance Service Providers that experienced staffing
19losses due to the COVID-19 public health emergency.
20        (1) Funds awarded under this paragraph (f) shall not
21    be expended for premium pay to eligible workers.
22        (2) Each Qualifying Ground Ambulance Service Provider
23    that receives funds under this paragraph (f) shall comply
24    with paragraph (c) of this Section.
25        (3) The Department shall require each Qualifying
26    Ground Ambulance Service Provider that receives funds

 

 

10200HB4846sam002- 55 -LRB102 25362 AMQ 41943 a

1    under this paragraph (f) to submit appropriate
2    documentation acknowledging compliance with State and
3    federal law on an annual basis.
4(Source: P.A. 102-699, eff. 4-19-22.)
 
5    (305 ILCS 5/5B-2)  (from Ch. 23, par. 5B-2)
6    Sec. 5B-2. Assessment; no local authorization to tax.
7    (a) For the privilege of engaging in the occupation of
8long-term care provider, beginning July 1, 2011 through June
930, 2022, or upon federal approval by the Centers for Medicare
10and Medicaid Services of the long-term care provider
11assessment described in subsection (a-1), whichever is later,
12an assessment is imposed upon each long-term care provider in
13an amount equal to $6.07 times the number of occupied bed days
14due and payable each month. Notwithstanding any provision of
15any other Act to the contrary, this assessment shall be
16construed as a tax, but shall not be billed or passed on to any
17resident of a nursing home operated by the nursing home
18provider.
19    (a-1) For the privilege of engaging in the occupation of
20long-term care provider for each occupied non-Medicare bed
21day, beginning July 1, 2022, an assessment is imposed upon
22each long-term care provider in an amount varying with the
23number of paid Medicaid resident days per annum in the
24facility with the following schedule of occupied bed tax
25amounts. This assessment is due and payable each month. The

 

 

10200HB4846sam002- 56 -LRB102 25362 AMQ 41943 a

1tax shall follow the schedule below and be rebased by the
2Department on an annual basis. The Department shall publish
3each facility's rebased tax rate according to the schedule in
4this Section 30 days prior to the beginning of the 6-month
5period beginning July 1, 2022 and thereafter 30 days prior to
6the beginning of each calendar year which shall incorporate
7the number of paid Medicaid days used to determine each
8facility's rebased tax rate.
9        (1) 0-5,000 paid Medicaid resident days per annum,
10    $10.67.
11        (2) 5,001-15,000 paid Medicaid resident days per
12    annum, $19.20.
13        (3) 15,001-35,000 paid Medicaid resident days per
14    annum, $22.40.
15        (4) 35,001-55,000 paid Medicaid resident days per
16    annum, $19.20.
17        (5) 55,001-65,000 paid Medicaid resident days per
18    annum, $13.86.
19        (6) 65,001+ paid Medicaid resident days per annum,
20    $10.67.
21        (7) Any non-profit nursing facilities without
22    Medicaid-certified beds or a nursing facility owned and
23    operated by a county government, $7 per occupied bed day.
24    Notwithstanding any provision of any other Act to the
25contrary, this assessment shall be construed as a tax but
26shall not be billed or passed on to any resident of a nursing

 

 

10200HB4846sam002- 57 -LRB102 25362 AMQ 41943 a

1home operated by the nursing home provider.
2    For each new calendar year and for the 6-month period
3beginning July 1, 2022, a facility's paid Medicaid resident
4days per annum shall be determined using the Department's
5Medicaid Management Information System to include Medicaid
6resident days for the year ending 9 months earlier.
7    (b) Nothing in this amendatory Act of 1992 shall be
8construed to authorize any home rule unit or other unit of
9local government to license for revenue or impose a tax or
10assessment upon long-term care providers or the occupation of
11long-term care provider, or a tax or assessment measured by
12the income or earnings or occupied bed days of a long-term care
13provider.
14    (c) The assessment imposed by this Section shall not be
15due and payable, however, until after the Department notifies
16the long-term care providers, in writing, that the payment
17methodologies to long-term care providers required under
18Section 5-5.2 of this Code have been approved by the Centers
19for Medicare and Medicaid Services of the U.S. Department of
20Health and Human Services and that the waivers under 42 CFR
21433.68 for the assessment imposed by this Section, if
22necessary, have been granted by the Centers for Medicare and
23Medicaid Services of the U.S. Department of Health and Human
24Services.
25(Source: P.A. 102-1035, eff. 5-31-22.)
 

 

 

10200HB4846sam002- 58 -LRB102 25362 AMQ 41943 a

1    Section 99. Effective date. This Act takes effect upon
2becoming law.".