Sen. Ann Gillespie
Filed: 11/29/2022
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1 | AMENDMENT TO HOUSE BILL 4846
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2 | AMENDMENT NO. ______. Amend House Bill 4846 by replacing | ||||||
3 | everything after the enacting clause with the following:
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4 | "Section 5. The Illinois Administrative Procedure Act is | ||||||
5 | amended 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 | ||||||
8 | hospitals. To provide for the expeditious and timely | ||||||
9 | implementation of this amendatory Act of the 102nd General | ||||||
10 | Assembly, emergency rules implementing the inclusion of rural | ||||||
11 | emergency hospitals in the definition of "hospital" in Section | ||||||
12 | 3 of the Hospital Licensing Act may be adopted in accordance | ||||||
13 | with Section 5-45 by the Department of Public Health. The | ||||||
14 | adoption of emergency rules authorized by Section 5-45 and | ||||||
15 | this Section is deemed to be necessary for the public | ||||||
16 | interest, safety, and welfare. |
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1 | This Section is repealed one year after the effective date | ||||||
2 | of this amendatory Act of the 102nd General Assembly. | ||||||
3 | Section 10. The Hospital Licensing Act is amended by | ||||||
4 | changing Section 3 as follows:
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5 | (210 ILCS 85/3)
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6 | Sec. 3. As used in this Act:
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7 | (A) "Hospital" means any institution, place, building, | ||||||
8 | buildings on a campus, or agency, public
or private, whether | ||||||
9 | organized for profit or not, devoted primarily to the
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10 | maintenance and operation of facilities for the diagnosis and | ||||||
11 | treatment or
care of 2 or more unrelated persons admitted for | ||||||
12 | overnight stay or longer
in order to obtain medical, including | ||||||
13 | obstetric, psychiatric and nursing,
care of illness, disease, | ||||||
14 | injury, infirmity, or deformity.
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15 | The term "hospital", without regard to length of stay, | ||||||
16 | shall also
include:
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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;
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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.
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11 | The term "hospital" includes general and specialized | ||||||
12 | hospitals,
tuberculosis sanitaria, mental or psychiatric | ||||||
13 | hospitals and sanitaria, and
includes maternity homes, | ||||||
14 | lying-in homes, and homes for unwed mothers in
which care is | ||||||
15 | given during delivery.
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16 | The term "hospital" does not include:
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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;
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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;
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26 | (3) hospitalization or care facilities maintained by |
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1 | the federal
government or agencies thereof;
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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;
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6 | (5) any person or facility required to be licensed | ||||||
7 | pursuant to the
Substance Use Disorder Act;
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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;
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12 | (7) an Alzheimer's disease management center | ||||||
13 | alternative health care
model licensed under the | ||||||
14 | Alternative Health Care Delivery Act; or
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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 | ||||||
21 | subdivision or municipal
corporation, individual, firm, | ||||||
22 | partnership, corporation, company,
association, or joint stock | ||||||
23 | association, or the legal successor thereof.
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24 | (C) "Department" means the Department of Public Health of | ||||||
25 | the State of
Illinois.
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26 | (D) "Director" means the Director of Public Health of
the |
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1 | State of Illinois.
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2 | (E) "Perinatal" means the period of time
between the | ||||||
3 | conception of an
infant and the end of the first month after | ||||||
4 | birth.
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5 | (F) "Federally designated organ procurement agency" means | ||||||
6 | the organ
procurement agency designated by the Secretary of | ||||||
7 | the U.S. Department of Health
and Human Services for the | ||||||
8 | service area in which a hospital is located; except
that in the | ||||||
9 | case of a hospital located in a county adjacent to Wisconsin
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10 | which currently contracts with an organ procurement agency | ||||||
11 | located in Wisconsin
that is not the organ procurement agency | ||||||
12 | designated by the U.S. Secretary of
Health and Human Services | ||||||
13 | for the service area in which the hospital is
located, if the | ||||||
14 | hospital applies for a waiver pursuant to 42 U.S.C. USC
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15 | 1320b-8(a), it may designate an organ procurement agency
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16 | located in Wisconsin to be thereafter deemed its federally | ||||||
17 | designated organ
procurement agency for the purposes of this | ||||||
18 | Act.
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19 | (G) "Tissue bank" means any facility or program operating | ||||||
20 | in Illinois
that is certified by the American Association of | ||||||
21 | Tissue Banks or the Eye Bank
Association of America and is | ||||||
22 | involved in procuring, furnishing, donating,
or distributing | ||||||
23 | corneas, bones, or other human tissue for the purpose of
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24 | injecting, transfusing, or transplanting any of them into the | ||||||
25 | human body.
"Tissue bank" does not include a licensed blood | ||||||
26 | bank. For the purposes of this
Act, "tissue" does not include |
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1 | organs.
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2 | (H) "Campus", as this term terms applies to operations, | ||||||
3 | has the same meaning as the term "campus" as set forth in | ||||||
4 | federal 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 | ||||||
7 | by changing Sections 30, 35, and 150 as follows: | ||||||
8 | (225 ILCS 6/30) | ||||||
9 | (Section scheduled to be repealed on January 1, 2028)
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10 | Sec. 30. Qualifications for behavior analyst license. | ||||||
11 | (a) A person qualifies to be licensed as a behavior | ||||||
12 | analyst 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 | ||||||
3 | behavior analyst seeking licensure as a licensed behavior | ||||||
4 | analyst
who (i) does not have the supervised experience as | ||||||
5 | described in paragraph (3) of subsection (a), (ii) applies for | ||||||
6 | licensure before July 1, 2028, and (iii) has completed all of | ||||||
7 | the 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 | ||||||
20 | to complete the application process. If the process has not | ||||||
21 | been completed in 3 years, the application shall be denied, | ||||||
22 | the fee shall be forfeited, and the applicant must reapply and | ||||||
23 | meet the requirements in effect at the time of reapplication. | ||||||
24 | (d) Each applicant for licensure as a an behavior analyst | ||||||
25 | shall have his or her fingerprints submitted to the Illinois | ||||||
26 | State Police in an electronic format that complies with the |
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1 | form and manner for requesting and furnishing criminal history | ||||||
2 | record information as prescribed by the Illinois State Police. | ||||||
3 | These fingerprints shall be transmitted through a live scan | ||||||
4 | fingerprint vendor licensed by the Department. These | ||||||
5 | fingerprints shall be checked against the Illinois State | ||||||
6 | Police and Federal Bureau of Investigation criminal history | ||||||
7 | record databases now and hereafter filed, including, but not | ||||||
8 | limited to, civil, criminal, and latent fingerprint databases. | ||||||
9 | The Illinois State Police shall charge a fee for conducting | ||||||
10 | the criminal history records check, which shall be deposited | ||||||
11 | in the State Police Services Fund and shall not exceed the | ||||||
12 | actual cost of the records check. The Illinois State Police | ||||||
13 | shall furnish, pursuant to positive identification, records of | ||||||
14 | Illinois convictions as prescribed under the Illinois Uniform | ||||||
15 | Conviction Information Act and shall forward the national | ||||||
16 | criminal history record information to the Department.
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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)
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20 | Sec. 35. Qualifications for assistant behavior analyst | ||||||
21 | license. | ||||||
22 | (a) A person qualifies to be licensed as an assistant | ||||||
23 | behavior 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 | ||||||
12 | assistant behavior analyst seeking licensure as a licensed | ||||||
13 | assistant behavior analyst who (i) does not have the | ||||||
14 | supervised experience as described in paragraph (3) of | ||||||
15 | subsection (a), (ii) applies for licensure before July 1, | ||||||
16 | 2028, 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 | ||||||
2 | to complete the application process. If the process has not | ||||||
3 | been completed in 3 years, the application shall be denied, | ||||||
4 | the fee shall be forfeited, and the applicant must reapply and | ||||||
5 | meet the requirements in effect at the time of reapplication. | ||||||
6 | (d) Each applicant for licensure as an assistant behavior | ||||||
7 | analyst shall have his or her fingerprints submitted to the | ||||||
8 | Illinois State Police in an electronic format that complies | ||||||
9 | with the form and manner for requesting and furnishing | ||||||
10 | criminal history record information as prescribed by the | ||||||
11 | Illinois State Police. These fingerprints shall be transmitted | ||||||
12 | through a live scan fingerprint vendor licensed by the | ||||||
13 | Department. These fingerprints shall be checked against the | ||||||
14 | Illinois State Police and Federal Bureau of Investigation | ||||||
15 | criminal history record databases now and hereafter filed, | ||||||
16 | including, but not limited to, civil, criminal, and latent | ||||||
17 | fingerprint databases. The Illinois State Police shall charge | ||||||
18 | a fee for conducting the criminal history records check, which | ||||||
19 | shall be deposited in the State Police Services Fund and shall | ||||||
20 | not exceed the actual cost of the records check. The Illinois | ||||||
21 | State Police shall furnish, pursuant to positive | ||||||
22 | identification, records of Illinois convictions as prescribed | ||||||
23 | under the Illinois Uniform Conviction Information Act and | ||||||
24 | shall forward the national criminal history record information | ||||||
25 | to the Department.
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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)
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3 | Sec. 150. License restrictions and limitations. | ||||||
4 | Notwithstanding the exclusion in paragraph (2) of subsection | ||||||
5 | (c) of Section 20 that permits an individual to implement a | ||||||
6 | behavior analytic treatment plan under the extended authority, | ||||||
7 | direction, and supervision of a licensed behavior analyst or | ||||||
8 | licensed assistant behavior analyst, no No business | ||||||
9 | organization shall provide, attempt to provide, or offer to | ||||||
10 | provide behavior analysis services unless every member, | ||||||
11 | partner, shareholder, director, officer, holder of any other | ||||||
12 | ownership interest, agent, and employee who renders applied | ||||||
13 | behavior analysis services holds a currently valid license | ||||||
14 | issued under this Act. No business shall be created that (i) | ||||||
15 | has a stated purpose that includes behavior analysis, or (ii) | ||||||
16 | practices or holds itself out as available to practice | ||||||
17 | behavior analysis therapy, unless it is organized under the | ||||||
18 | Professional Service Corporation Act or Professional Limited | ||||||
19 | Liability Company Act. Nothing in this Act shall preclude | ||||||
20 | individuals licensed under this Act from practicing directly | ||||||
21 | or indirectly for a physician licensed to practice medicine in | ||||||
22 | all its branches under the Medical Practice Act of 1987 or for | ||||||
23 | any legal entity as provided under subsection (c) of Section | ||||||
24 | 22.2 of the Medical Practice Act of 1987.
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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 | ||||||
2 | amended by adding Section 18.1 as follows: | ||||||
3 | (225 ILCS 100/18.1 new) | ||||||
4 | Sec. 18.1. Fee waivers. Notwithstanding any provision of | ||||||
5 | law to the contrary, during State Fiscal Year 2023, the | ||||||
6 | Department shall allow individuals a one-time waiver of fees | ||||||
7 | imposed under Section 18 of this Act. No individual may | ||||||
8 | benefit from such a waiver more than once. If an individual has | ||||||
9 | already paid a fee required under Section 18 for Fiscal Year | ||||||
10 | 2023, then the Department shall apply the money paid for that | ||||||
11 | fee as a credit to the next required fee. | ||||||
12 | Section 25. The Nurse Agency Licensing Act is amended by | ||||||
13 | changing Sections 3, 14, and 14.3 as follows:
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14 | (225 ILCS 510/3) (from Ch. 111, par. 953)
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15 | Sec. 3. Definitions. As used in this Act:
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16 | "Certified nurse aide" means an individual certified as | ||||||
17 | defined in
Section 3-206 of the Nursing Home Care Act, Section | ||||||
18 | 3-206 of the ID/DD Community Care Act, or Section 3-206 of the | ||||||
19 | MC/DD Act, as now or hereafter amended.
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20 | "Covenant not to compete" means an agreement between a | ||||||
21 | nurse agency and an employee that restricts the employee from | ||||||
22 | performing: |
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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.
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8 | "Director" means the Director of Labor.
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9 | "Employee" means a nurse or a certified nurse aide. | ||||||
10 | "Health care facility" is defined as in Section 3 of the | ||||||
11 | Illinois
Health Facilities Planning Act, as now or hereafter | ||||||
12 | amended. "Health care facility" also includes any facility | ||||||
13 | licensed, certified, or approved by any State agency and | ||||||
14 | subject to regulation under the Assisted Living and Shared | ||||||
15 | Housing Act or the Illinois Public Aid Code.
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16 | "Licensee" means any nurse nursing agency which is | ||||||
17 | properly licensed under
this Act. | ||||||
18 | "Long-term basis" means an initial employment, assignment, | ||||||
19 | or referral term of more than 24 continuous months.
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20 | "Nurse" means a registered nurse, a licensed practical | ||||||
21 | nurse, an advanced practice registered nurse, or any | ||||||
22 | individual licensed under the Nurse Practice Act.
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23 | "Nurse agency" means any individual, firm, corporation,
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24 | partnership , or other legal entity that employs, assigns , or | ||||||
25 | refers nurses
or certified nurse aides to a health care | ||||||
26 | facility for a
fee. The term "nurse agency" includes nurses |
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1 | registries. The term "nurse
agency" does not include services | ||||||
2 | provided by home
health agencies licensed and operated under | ||||||
3 | the Home Health, Home Services, and Home Nursing Agency
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4 | Licensing Act or a licensed or certified
individual who | ||||||
5 | provides his or her own services as a regular employee of a
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6 | health care facility, nor does it apply to a health care | ||||||
7 | facility's
organizing nonsalaried employees to provide | ||||||
8 | services only in that
facility.
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9 | "Temporary basis" means an initial employment, assignment, | ||||||
10 | or referral term of 24 continuous months or less exclusive of | ||||||
11 | any extension. | ||||||
12 | (Source: P.A. 102-946, eff. 7-1-22.)
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13 | (225 ILCS 510/14) (from Ch. 111, par. 964)
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14 | Sec. 14. Minimum Standards. | ||||||
15 | (a) The Department, by rule, shall
establish minimum | ||||||
16 | standards for the operation of nurse agencies. Those
standards | ||||||
17 | shall 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
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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.
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15 | The requirements to maintain and submit contracts and | ||||||
16 | invoices to the Department under subparagraphs (2) and (3) of | ||||||
17 | this subsection do not apply to (i) contracts on a long-term | ||||||
18 | basis for the employment, assignment, or referral of nurses by | ||||||
19 | a nurse agency to a health care facility, (ii) contracts on a | ||||||
20 | long-term basis for the employment, assignment, or referral of | ||||||
21 | certified nurse aides by a nurse agency to a health care | ||||||
22 | facility, or (iii) invoices for contracts described in item | ||||||
23 | (i) or (ii). However, a nurse agency that is exempt from the | ||||||
24 | requirements of subparagraphs (2) and (3) of this subsection | ||||||
25 | must 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 | ||||||
2 | manager or
supervisor of all nurses and certified nurses | ||||||
3 | aides.
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4 | (c) Each nurse agency shall
ensure that its employees meet | ||||||
5 | the minimum
licensing, training, continuing education, and | ||||||
6 | orientation standards for
which those employees
are licensed | ||||||
7 | or certified.
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8 | (d) A nurse agency shall not employ, assign, or refer for | ||||||
9 | use in an Illinois
health care facility a nurse or certified | ||||||
10 | nurse aide unless certified or
licensed under applicable | ||||||
11 | provisions of State and federal law or regulations.
Each | ||||||
12 | certified nurse aide shall comply with all pertinent
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13 | regulations of the Illinois Department of Public Health | ||||||
14 | relating to the
health and other qualifications of personnel | ||||||
15 | employed in health care facilities.
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16 | (e) The Department may adopt rules to monitor the usage of | ||||||
17 | nurse agency services to
determine their impact.
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18 | (f) Nurse agencies are prohibited from recruiting | ||||||
19 | potential employees on the premises of a health care facility | ||||||
20 | or requiring, as a condition of
employment, assignment, or | ||||||
21 | referral, that their employees
recruit new employees for the | ||||||
22 | nurse agency from
among the permanent employees of the health | ||||||
23 | care facility to which the
nurse agency employees have been | ||||||
24 | employed,
assigned, or referred,
and the health care facility | ||||||
25 | to which such employees are employed, assigned,
or referred is | ||||||
26 | prohibited from requiring, as a condition of employment,
that |
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1 | their employees recruit new employees from these nurse agency
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2 | employees. Violation of this provision is a business offense.
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3 | (g) Nurse agencies are prohibited from entering into | ||||||
4 | covenants not to compete with nurses and certified nurse aides | ||||||
5 | if the nurse is employed, assigned, or referred by a nurse | ||||||
6 | agency to a health care facility on a temporary basis or the | ||||||
7 | certified nurse aide is employed, assigned, or referred by a | ||||||
8 | nurse agency to a health care facility on a temporary basis . A | ||||||
9 | covenant not to compete entered into on or after July 1, 2022 | ||||||
10 | ( the effective date of Public Act 102-946) this amendatory Act | ||||||
11 | of the 102nd General Assembly between a nurse agency and a | ||||||
12 | nurse or a certified nurse aide is illegal and void if (i) the | ||||||
13 | nurse is employed, assigned, or referred by a nurse agency to a | ||||||
14 | health care facility on a temporary basis or (ii) the | ||||||
15 | certified nurse aide is employed, assigned, or referred by a | ||||||
16 | nurse agency to a health care facility on a temporary basis is | ||||||
17 | illegal and void . The nurse nursing agency shall not, in any | ||||||
18 | contract on a temporary basis with any nurse, certified nurse | ||||||
19 | aide, employee or health care facility, require the payment of | ||||||
20 | liquidated damages, conversion fees, employment fees, buy-out | ||||||
21 | fees, placement fees, or other compensation if the nurse or | ||||||
22 | certified nurse aide employee is hired as a permanent employee | ||||||
23 | of the a health care facility. However, a nurse agency may, in | ||||||
24 | a contract on a long-term basis with any nurse, certified | ||||||
25 | nurse aide, or health care facility, require the payment of | ||||||
26 | liquidated damages, conversion fees, employment fees, buy-out |
| |||||||
| |||||||
1 | fees, placement fees, or other compensation if the nurse or | ||||||
2 | certified nurse aide is hired before the expiration of a | ||||||
3 | covenant not to compete as a permanent employee of the health | ||||||
4 | care facility. | ||||||
5 | (h) A nurse agency shall submit a report quarterly to the | ||||||
6 | Department for each health care entity with whom the agency | ||||||
7 | contracts that includes all of the following by provider type | ||||||
8 | and 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 | ||||||
19 | was performed the average amount charged to the health care | ||||||
20 | facilities by nurse agencies for each individual worker | ||||||
21 | category and the average amount paid by the agency to each | ||||||
22 | individual worker category. This subsection does not apply to | ||||||
23 | a nurse or certified nurse aide if the nurse or certified nurse | ||||||
24 | aide is employed, assigned, or referred by a nurse agency to a | ||||||
25 | health care facility on a long-term basis. However, a nurse | ||||||
26 | agency that is exempt from the requirements of this subsection |
| |||||||
| |||||||
1 | must submit the information required by this subsection upon | ||||||
2 | request by the Department pursuant to Section 14.1. | ||||||
3 | (i) The Department shall publish on its website the | ||||||
4 | reports yearly by county. | ||||||
5 | (j) The Department of Labor shall compel production of the | ||||||
6 | maintained records, as required under this Section, by the | ||||||
7 | nurse 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 | ||||||
11 | care facilities. | ||||||
12 | (a) A contract entered into on or after the effective date | ||||||
13 | of this amendatory Act of the 102nd General Assembly between | ||||||
14 | the nurse agency and health care facility must contain the | ||||||
15 | following 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 |
| |||||||
| |||||||
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 | ||||||
8 | subsection (a) shall be a defense to the enforcement of a | ||||||
9 | contract between a nurse agency and a health care facility. | ||||||
10 | Any health care facility or nurse agency aggrieved by a | ||||||
11 | violation of subsection (a) shall have a right of action in a | ||||||
12 | State court against the offending party. A prevailing party | ||||||
13 | may 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 | ||||||
21 | long-term basis between a nurse agency and a health care | ||||||
22 | facility providing for the employment, assignment, or referral | ||||||
23 | of nurses or certified nurse aides to the health care | ||||||
24 | facility. However, a nurse agency that is exempt from the | ||||||
25 | requirements of this Section must submit the information | ||||||
26 | required by this Section upon request by the Department |
| |||||||
| |||||||
1 | pursuant 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 | ||||||
4 | changing 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 | ||||||
8 | September 30, 1992.
Notwithstanding any other provisions of | ||||||
9 | this Code or the Illinois
Department's Rules promulgated under | ||||||
10 | the Illinois Administrative Procedure
Act, reimbursement to | ||||||
11 | hospitals for services provided during the period
July 1, 1992 | ||||||
12 | through 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,
|
| |||||||
| |||||||
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 |
| |||||||
| |||||||
1 | or after October
1, 1993, in addition to rates paid for | ||||||
2 | hospital inpatient services pursuant to
the Illinois Health | ||||||
3 | Finance Reform Act, as now or hereafter amended, or the
| ||||||
4 | Illinois Department's prospective reimbursement methodology, | ||||||
5 | or any other
methodology used by the Illinois Department for | ||||||
6 | inpatient services, the
Illinois Department shall make | ||||||
7 | adjustment payments, in an amount calculated
pursuant to the | ||||||
8 | methodology described in paragraph (c) of this Section, to
| ||||||
9 | hospitals that the Illinois Department determines satisfy any | ||||||
10 | one 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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
1 | this Code. | ||||||
2 | (c) Inpatient adjustment payments. The adjustment payments | ||||||
3 | required by
paragraph (b) shall be calculated based upon the | ||||||
4 | hospital'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 |
| |||||||
| |||||||
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 | ||||||
13 | thereafter, the Medicaid Inpatient utilization rate, as | ||||||
14 | defined in paragraph (1) of subsection (h) and used in the | ||||||
15 | determination of eligibility for payments under paragraph (c), | ||||||
16 | shall be modified to exclude from both the numerator and | ||||||
17 | denominator all days of care provided to military recruits or | ||||||
18 | trainees for the United States Navy and covered by TriCare or | ||||||
19 | its successor. | ||||||
20 | (d) Supplemental adjustment payments. In addition to the | ||||||
21 | adjustment
payments described in paragraph (c), hospitals as | ||||||
22 | defined in clauses
(1) through (6) of paragraph (b), excluding | ||||||
23 | county hospitals (as defined in
subsection (c) of Section 15-1 | ||||||
24 | of this Code) and a hospital organized under the
University of | ||||||
25 | Illinois Hospital Act, shall be paid supplemental inpatient
| ||||||
26 | adjustment payments of $60 per day. For purposes of Title XIX |
| |||||||
| |||||||
1 | of the federal
Social Security Act, these supplemental | ||||||
2 | adjustment payments shall not be
classified as adjustment | ||||||
3 | payments to disproportionate share hospitals.
| ||||||
4 | (e) The inpatient adjustment payments described in | ||||||
5 | paragraphs (c) and (d)
shall be increased on October 1, 1993 | ||||||
6 | and annually thereafter by a percentage
equal to the lesser of | ||||||
7 | (i) the increase in the DRI hospital cost index for the
most | ||||||
8 | recent 12-month 12 month period for which data are available, | ||||||
9 | or (ii) the
percentage increase in the statewide average | ||||||
10 | hospital payment rate over the
previous year's statewide | ||||||
11 | average hospital payment rate. The sum of the
inpatient | ||||||
12 | adjustment payments under paragraphs (c) and (d) to a | ||||||
13 | hospital, other
than a county hospital (as defined in | ||||||
14 | subsection (c) of Section 15-1 of this
Code) or a hospital | ||||||
15 | organized under the University of Illinois Hospital Act,
| ||||||
16 | however, shall not exceed $275 per day; that limit shall be | ||||||
17 | increased on
October 1, 1993 and annually thereafter by a | ||||||
18 | percentage equal to the lesser of
(i) the increase in the DRI | ||||||
19 | hospital cost index for the most recent 12-month
period for | ||||||
20 | which data are available or (ii) the percentage increase in | ||||||
21 | the
statewide average hospital payment rate over the previous | ||||||
22 | year's statewide
average hospital payment rate.
| ||||||
23 | (f) Children's hospital inpatient adjustment payments. For | ||||||
24 | children'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.
|
| |||||||
| |||||||
1 | (g) County hospital inpatient adjustment payments. For | ||||||
2 | county hospitals,
as defined in subsection (c) of Section 15-1 | ||||||
3 | of this Code, there shall be an
adjustment payment as | ||||||
4 | determined by rules issued by the Illinois Department.
| ||||||
5 | (h) For the purposes of this Section the following terms | ||||||
6 | shall 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 | ||||||
24 | the limits
of Public Law 102-234 and Public Law 103-66, the
| ||||||
25 | Illinois Department shall by rule adjust
disproportionate | ||||||
26 | share adjustment payments.
|
| |||||||
| |||||||
1 | (j) University of Illinois Hospital inpatient adjustment | ||||||
2 | payments. For
hospitals organized under the University of | ||||||
3 | Illinois Hospital Act, there shall
be an adjustment payment as | ||||||
4 | determined by rules adopted by the Illinois
Department.
| ||||||
5 | (k) The Illinois Department may by rule establish criteria | ||||||
6 | for and develop
methodologies for adjustment payments to | ||||||
7 | hospitals participating under this
Article.
| ||||||
8 | (l) On and after July 1, 2012, the Department shall reduce | ||||||
9 | any rate of reimbursement for services or other payments or | ||||||
10 | alter any methodologies authorized by this Code to reduce any | ||||||
11 | rate of reimbursement for services or other payments in | ||||||
12 | accordance with Section 5-5e. | ||||||
13 | (m) The Department shall establish a cost-based | ||||||
14 | reimbursement methodology for determining payments to | ||||||
15 | hospitals for approved graduate medical education (GME) | ||||||
16 | programs 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; |
| |||||||
| |||||||
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. |
| |||||||
| |||||||
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; | ||||||
13 | 102-886, 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 | ||||||
17 | Section
5-5.1 of this Act shall receive the same rate of | ||||||
18 | payment for similar
services.
| ||||||
19 | (b) It shall be a matter of State policy that the Illinois | ||||||
20 | Department
shall utilize a uniform billing cycle throughout | ||||||
21 | the State for the
long-term care providers.
| ||||||
22 | (c) (Blank). | ||||||
23 | (c-1) Notwithstanding any other provisions of this Code, | ||||||
24 | the methodologies for reimbursement of nursing services as | ||||||
25 | provided under this Article shall no longer be applicable for |
| |||||||
| |||||||
1 | bills payable for nursing services rendered on or after a new | ||||||
2 | reimbursement system based on the Patient Driven Payment Model | ||||||
3 | (PDPM) has been fully operationalized, which shall take effect | ||||||
4 | for services provided on or after the implementation of the | ||||||
5 | PDPM reimbursement system begins. For the purposes of this | ||||||
6 | amendatory Act of the 102nd General Assembly, the | ||||||
7 | implementation date of the PDPM reimbursement system and all | ||||||
8 | related provisions shall be July 1, 2022 if the following | ||||||
9 | conditions are met: (i) the Centers for Medicare and Medicaid | ||||||
10 | Services has approved corresponding changes in the | ||||||
11 | reimbursement system and bed assessment; and (ii) the | ||||||
12 | Department has filed rules to implement these changes no later | ||||||
13 | than June 1, 2022. Failure of the Department to file rules to | ||||||
14 | implement the changes provided in this amendatory Act of the | ||||||
15 | 102nd General Assembly no later than June 1, 2022 shall result | ||||||
16 | in the implementation date being delayed to October 1, 2022. | ||||||
17 | (d) The new nursing services reimbursement methodology | ||||||
18 | utilizing the Patient Driven Payment Model, which shall be | ||||||
19 | referred to as the PDPM reimbursement system, taking effect | ||||||
20 | July 1, 2022, upon federal approval by the Centers for | ||||||
21 | Medicare and Medicaid Services, shall be based on the | ||||||
22 | following: | ||||||
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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 | ||||||
19 | base 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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 | ||||||
20 | funding in the amount up to $10,000,000 for per diem add-ons to | ||||||
21 | the RUGS methodology for dates of service on and after July 1, | ||||||
22 | 2014: | ||||||
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 |
| |||||||
| |||||||
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 | ||||||
7 | ending September 30, 2023, the RUG-IV nursing component per | ||||||
8 | diem for a nursing home shall be the product of the statewide | ||||||
9 | RUG-IV nursing base per diem rate, the facility average case | ||||||
10 | mix index, and the regional wage adjustor. | ||||||
11 | (e-3) A Medicaid Access Adjustment of $4 adjusted for the | ||||||
12 | facility average PDPM case mix index calculated quarterly | ||||||
13 | shall be added to the statewide PDPM nursing per diem for all | ||||||
14 | facilities with annual Medicaid bed days of at least 70% of all | ||||||
15 | occupied bed days adjusted quarterly. For each new calendar | ||||||
16 | year and for the 6-month period beginning July 1, 2022, the | ||||||
17 | percentage of a facility's occupied bed days comprised of | ||||||
18 | Medicaid bed days shall be determined by the Department | ||||||
19 | quarterly. Beginning on the effective date of this amendatory | ||||||
20 | Act of the 102nd General Assembly, the Medicaid Access | ||||||
21 | Adjustment of $4 shall be increased by $0.75 and the increased | ||||||
22 | reimbursement rate shall be applied to services rendered on | ||||||
23 | and after July 1, 2022. The Department shall recalculate each | ||||||
24 | affected facility's reimbursement rate retroactive to July 1, | ||||||
25 | 2022 and remit all additional money owed to each facility as a | ||||||
26 | result of the retroactive recalculation. This subsection shall |
| |||||||
| |||||||
1 | be inoperative on and after January 1, 2028. | ||||||
2 | (f) (Blank). | ||||||
3 | (g) Notwithstanding any other provision of this Code, on | ||||||
4 | and after July 1, 2012, for facilities not designated by the | ||||||
5 | Department of Healthcare and Family Services as "Institutions | ||||||
6 | for Mental Disease", rates effective May 1, 2011 shall be | ||||||
7 | adjusted 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 | ||||||
13 | and after July 1, 2012, nursing facilities designated by the | ||||||
14 | Department of Healthcare and Family Services as "Institutions | ||||||
15 | for Mental Disease" and "Institutions for Mental Disease" that | ||||||
16 | are facilities licensed under the Specialized Mental Health | ||||||
17 | Rehabilitation Act of 2013 shall have the nursing, | ||||||
18 | socio-developmental, capital, and support components of their | ||||||
19 | reimbursement rate effective May 1, 2011 reduced in total by | ||||||
20 | 2.7%. | ||||||
21 | (i) On and after July 1, 2014, the reimbursement rates for | ||||||
22 | the support component of the nursing facility rate for | ||||||
23 | facilities licensed under the Nursing Home Care Act as skilled | ||||||
24 | or intermediate care facilities shall be the rate in effect on | ||||||
25 | June 30, 2014 increased by 8.17%. | ||||||
26 | (j) Notwithstanding any other provision of law, subject to |
| |||||||
| |||||||
1 | federal approval, effective July 1, 2019, sufficient funds | ||||||
2 | shall be allocated for changes to rates for facilities | ||||||
3 | licensed under the Nursing Home Care Act as skilled nursing | ||||||
4 | facilities or intermediate care facilities for dates of | ||||||
5 | services on and after July 1, 2019: (i) to establish, through | ||||||
6 | June 30, 2022 a per diem add-on to the direct care per diem | ||||||
7 | rate not to exceed $70,000,000 annually in the aggregate | ||||||
8 | taking into account federal matching funds for the purpose of | ||||||
9 | addressing the facility's unique staffing needs, adjusted | ||||||
10 | quarterly and distributed by a weighted formula based on | ||||||
11 | Medicaid bed days on the last day of the second quarter | ||||||
12 | preceding the quarter for which the rate is being adjusted. | ||||||
13 | Beginning July 1, 2022, the annual $70,000,000 described in | ||||||
14 | the preceding sentence shall be dedicated to the variable per | ||||||
15 | diem add-on for staffing under paragraph (6) of subsection | ||||||
16 | (d); and (ii) in an amount not to exceed $170,000,000 annually | ||||||
17 | in the aggregate taking into account federal matching funds to | ||||||
18 | permit the support component of the nursing facility rate to | ||||||
19 | be 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. |
| |||||||
| |||||||
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, | ||||||
10 | the Department of Healthcare of Family Services must convene a | ||||||
11 | technical advisory group consisting of members of all trade | ||||||
12 | associations representing Illinois skilled nursing providers | ||||||
13 | to discuss changes necessary with federal implementation of | ||||||
14 | Medicare's Patient-Driven Payment Model. Implementation of | ||||||
15 | Medicare's Patient-Driven Payment Model shall, by September 1, | ||||||
16 | 2020, end the collection of the MDS data that is necessary to | ||||||
17 | maintain the current RUG-IV Medicaid payment methodology. The | ||||||
18 | technical advisory group must consider a revised reimbursement | ||||||
19 | methodology that takes into account transparency, | ||||||
20 | accountability, actual staffing as reported under the | ||||||
21 | federally required Payroll Based Journal system, changes to | ||||||
22 | the minimum wage, adequacy in coverage of the cost of care, and | ||||||
23 | a quality component that rewards quality improvements. | ||||||
24 | (l) The Department shall establish per diem add-on | ||||||
25 | payments to improve the quality of care delivered by | ||||||
26 | facilities, including: |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 |
| |||||||
| |||||||
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 | ||||||
6 | industry representatives to design policies and procedures to | ||||||
7 | permit facilities to address the integrity of data from | ||||||
8 | federal reporting sites used by the Department in setting | ||||||
9 | facility rates. | ||||||
10 | (Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19; | ||||||
11 | 102-77, eff. 7-9-21; 102-558, eff. 8-20-21; 102-1035, eff. | ||||||
12 | 5-31-22 .)
| ||||||
13 | (305 ILCS 5/5-5.7b) | ||||||
14 | Sec. 5-5.7b. Pandemic related stability payments to | ||||||
15 | ambulance service providers in response to COVID-19. | ||||||
16 | (a) Definitions. As used in this Section: | ||||||
17 | "Ambulance Services Industry" means the industry that is | ||||||
18 | comprised of "Qualifying Ground Ambulance Service Providers", | ||||||
19 | as defined in this Section. | ||||||
20 | "Qualifying Ground Ambulance Service Provider" means a | ||||||
21 | "vehicle service provider," as that term is defined in Section | ||||||
22 | 3.85 of the Emergency Medical Services (EMS) Systems Act, | ||||||
23 | which operates licensed ambulances for the purpose of | ||||||
24 | providing emergency, non-emergency ambulance services, or both | ||||||
25 | emergency and non-emergency ambulance services. The term |
| |||||||
| |||||||
1 | "Qualifying Ground Ambulance Service Provider" is limited to | ||||||
2 | ambulance and EMS agencies that are privately held and | ||||||
3 | nonprofit organizations headquartered within the State and | ||||||
4 | licensed by the Department of Public Health as of March 12, | ||||||
5 | 2020. | ||||||
6 | "Eligible worker" means a staff member of a Qualifying | ||||||
7 | Ground Ambulance Service Provider engaged in "essential work", | ||||||
8 | as defined by Section 9901 of the ARPA and related federal | ||||||
9 | guidance, and (1) whose total pay is below 150% of the average | ||||||
10 | annual wage for all occupations in the worker's county of | ||||||
11 | residence, as defined by the BLS Occupational Employment and | ||||||
12 | Wage Statistics or (2) is not exempt from the federal Fair | ||||||
13 | Labor Standards Act overtime provisions. | ||||||
14 | (b) Purpose. The Department may receive federal funds | ||||||
15 | under the authority of legislation passed in response to the | ||||||
16 | Coronavirus epidemic, including, but not limited to, the | ||||||
17 | American Rescue Plan Act of 2021, P.L. 117-2 (the "ARPA"). | ||||||
18 | Upon receipt or availability of such State or federal funds, | ||||||
19 | and subject to appropriations for their use, the Department | ||||||
20 | shall establish and administer programs for purposes allowable | ||||||
21 | under Section 9901 of the ARPA to provide financial assistance | ||||||
22 | to Qualifying Ground Ambulance Service Providers for premium | ||||||
23 | pay for eligible workers, to provide reimbursement for | ||||||
24 | eligible expenditures, and to provide support following the | ||||||
25 | negative economic impact of the COVID-19 public health | ||||||
26 | emergency on the Ambulance Services Industry. Financial |
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1 | assistance may include, but is not limited to, grants, expense | ||||||
2 | reimbursements, or subsidies. | ||||||
3 | (b-1) By December 31, 2022, the Department shall obtain | ||||||
4 | appropriate documentation from Qualifying Ground Ambulance | ||||||
5 | Service Providers to ascertain an accurate count of the number | ||||||
6 | of licensed vehicles available to serve enrollees in the | ||||||
7 | State's Medical Assistance Programs, which shall be known as | ||||||
8 | the "total eligible vehicles". By February 28, 2023, | ||||||
9 | Qualifying Ground Ambulance Service Providers shall be | ||||||
10 | initially notified of their eligible award, which shall be the | ||||||
11 | product of (i) the total amount of funds allocated under this | ||||||
12 | Section and (ii) a quotient, the numerator of which is the | ||||||
13 | number of licensed ground ambulance vehicles of an individual | ||||||
14 | Qualifying Ground Ambulance Service Provider and the | ||||||
15 | denominator of which is the total eligible vehicles. After | ||||||
16 | March 31, 2024, any unobligated funds shall be reallocated pro | ||||||
17 | rata to the remaining Qualifying Ground Ambulance Service | ||||||
18 | Providers that are able to prove up eligible expenses in | ||||||
19 | excess of their initial award amount until all such | ||||||
20 | appropriated funds are exhausted. | ||||||
21 | Providers shall indicate to the Department what portion of | ||||||
22 | their award they wish to allocate under the purposes outlined | ||||||
23 | under paragraphs (d), (e), or (f), if applicable, of this | ||||||
24 | Section. | ||||||
25 | (c) Non-Emergency Service Certification. To be eligible | ||||||
26 | for funding under this Section, a Qualifying Ground Ambulance |
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| |||||||
1 | Service Provider that provides non-emergency services to | ||||||
2 | institutional residents must certify whether or not it is able | ||||||
3 | to that it will provide non-emergency ambulance services to | ||||||
4 | individuals enrolled in the State's Medical Assistance Program | ||||||
5 | and residing in non-institutional settings for at least one | ||||||
6 | year following the receipt of funding pursuant to this | ||||||
7 | amendatory Act of the 102nd General Assembly. Certification | ||||||
8 | indicating that a provider has such an ability does not mean | ||||||
9 | that a provider is required to accept any or all requested | ||||||
10 | transports. The provider shall maintain the certification in | ||||||
11 | its records. The provider shall also maintain documentation of | ||||||
12 | all non-emergency ambulance services for the period covered by | ||||||
13 | the certification. The provider shall produce the | ||||||
14 | certification and supporting documentation upon demand by the | ||||||
15 | Department or its representative. Failure to comply shall | ||||||
16 | result in recovery of any payments made by the Department. | ||||||
17 | (d) Premium Pay Initiative. Subject to paragraph (c) of | ||||||
18 | this Section, the Department shall establish a Premium Pay | ||||||
19 | Initiative to distribute awards to each Qualifying Ground | ||||||
20 | Ambulance Service Provider for the purpose of providing | ||||||
21 | premium 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 | ||||||
25 | paragraph (c) of this Section and based on an application | ||||||
26 | filed by a Qualifying Ground Ambulance Service Provider, the |
| |||||||
| |||||||
1 | Department shall establish the Ground Ambulance COVID-19 | ||||||
2 | Response Support Initiative. The purpose of the award shall be | ||||||
3 | to reimburse Qualifying Ground Ambulance Service Providers for | ||||||
4 | eligible expenses under Section 9901 of the ARPA related to | ||||||
5 | the public health impacts of the COVID-19 public health | ||||||
6 | emergency, including , but not limited to : (i) costs incurred | ||||||
7 | due to the COVID-19 public health emergency; (ii) costs | ||||||
8 | related to vaccination programs, including vaccine incentives; | ||||||
9 | (iii) costs related to COVID-19 testing; (iv) costs related to | ||||||
10 | COVID-19 prevention and treatment equipment; (v) expenses for | ||||||
11 | medical supplies; (vi) expenses for personal protective | ||||||
12 | equipment; (vii) costs related to isolation and quarantine; | ||||||
13 | (viii) costs for ventilation system installation and | ||||||
14 | improvement; (ix) costs related to other emergency response | ||||||
15 | equipment, such as ground ambulances, ventilators, cardiac | ||||||
16 | monitoring equipment, defibrillation equipment, pacing | ||||||
17 | equipment, ambulance stretchers, and radio equipment; and (x) | ||||||
18 | other emergency medical response expenses. costs related to | ||||||
19 | COVID-19 testing for patients, COVID-19 prevention and | ||||||
20 | treatment equipment, medical supplies, personal protective | ||||||
21 | equipment, 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 |
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| |||||||
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 | ||||||
14 | designates the Ambulance Services Industry as an "impacted | ||||||
15 | industry", as defined by the ARPA and related federal | ||||||
16 | guidance, the Department shall establish the Ambulance | ||||||
17 | Industry Recovery Grant Program, to provide aid to Qualifying | ||||||
18 | Ground Ambulance Service Providers that experienced staffing | ||||||
19 | losses 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 |
| |||||||
| |||||||
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 | ||||||
8 | long-term care
provider, beginning July 1, 2011 through June | ||||||
9 | 30, 2022, or upon federal approval by the Centers for Medicare | ||||||
10 | and Medicaid Services of the long-term care provider | ||||||
11 | assessment described in subsection (a-1), whichever is later, | ||||||
12 | an assessment is imposed upon each long-term care provider in | ||||||
13 | an amount equal to $6.07 times the number of occupied bed days | ||||||
14 | due and payable each month. Notwithstanding any provision of | ||||||
15 | any other Act to the
contrary, this assessment shall be | ||||||
16 | construed as a tax, but shall not be billed or passed on to any | ||||||
17 | resident of a nursing home operated by the nursing home | ||||||
18 | provider.
| ||||||
19 | (a-1) For the privilege of engaging in the occupation of | ||||||
20 | long-term care provider for each occupied non-Medicare bed | ||||||
21 | day, beginning July 1, 2022, an assessment is imposed upon | ||||||
22 | each long-term care provider in an amount varying with the | ||||||
23 | number of paid Medicaid resident days per annum in the | ||||||
24 | facility with the following schedule of occupied bed tax | ||||||
25 | amounts. This assessment is due and payable each month. The |
| |||||||
| |||||||
1 | tax shall follow the schedule below and be rebased by the | ||||||
2 | Department on an annual basis. The Department shall publish | ||||||
3 | each facility's rebased tax rate according to the schedule in | ||||||
4 | this Section 30 days prior to the beginning of the 6-month | ||||||
5 | period beginning July 1, 2022 and thereafter 30 days prior to | ||||||
6 | the beginning of each calendar year which shall incorporate | ||||||
7 | the number of paid Medicaid days used to determine each | ||||||
8 | facility'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 | ||||||
25 | contrary, this assessment shall be construed as a tax but | ||||||
26 | shall not be billed or passed on to any resident of a nursing |
| |||||||
| |||||||
1 | home operated by the nursing home provider. | ||||||
2 | For each new calendar year and for the 6-month period | ||||||
3 | beginning July 1, 2022, a facility's paid Medicaid resident | ||||||
4 | days per annum shall be determined using the Department's | ||||||
5 | Medicaid Management Information System to include Medicaid | ||||||
6 | resident days for the year ending 9 months earlier. | ||||||
7 | (b) Nothing in this amendatory Act of 1992 shall be | ||||||
8 | construed to
authorize any home rule unit or other unit of | ||||||
9 | local government to license
for revenue or impose a tax or | ||||||
10 | assessment upon long-term care providers or
the occupation of | ||||||
11 | long-term care provider, or a tax or assessment measured
by | ||||||
12 | the income or earnings or occupied bed days of a long-term care | ||||||
13 | provider.
| ||||||
14 | (c) The assessment imposed by this Section shall not be | ||||||
15 | due and payable, however, until after the Department notifies | ||||||
16 | the long-term care providers, in writing, that the payment | ||||||
17 | methodologies to long-term care providers required under | ||||||
18 | Section 5-5.2 of this Code have been approved by the Centers | ||||||
19 | for Medicare and Medicaid Services of the U.S. Department of | ||||||
20 | Health and Human Services and that the waivers under 42 CFR | ||||||
21 | 433.68 for the assessment imposed by this Section, if | ||||||
22 | necessary, have been granted by the Centers for Medicare and | ||||||
23 | Medicaid Services of the U.S. Department of Health and Human | ||||||
24 | Services. | ||||||
25 | (Source: P.A. 102-1035, eff. 5-31-22.)
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| |||||||
1 | Section 99. Effective date. This Act takes effect upon | ||||||
2 | becoming law.".
|