093_HB0701sam001
LRB093 05499 DRJ 15754 a
1 AMENDMENT TO HOUSE BILL 701
2 AMENDMENT NO. . Amend House Bill 701 by replacing
3 everything after the enacting clause with the following:
4 "Section 5. The Illinois Public Aid Code is amended by
5 changing Section 5-5.4 as follows:
6 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
7 Sec. 5-5.4. Standards of Payment - Department of Public
8 Aid. The Department of Public Aid shall develop standards of
9 payment of skilled nursing and intermediate care services in
10 facilities providing such services under this Article which:
11 (1) Provide for the determination of a facility's
12 payment for skilled nursing and intermediate care services on
13 a prospective basis. The amount of the payment rate for all
14 nursing facilities certified under the medical assistance
15 program shall be prospectively established annually on the
16 basis of historical, financial, and statistical data
17 reflecting actual costs from prior years, which shall be
18 applied to the current rate year and updated for inflation,
19 except that the capital cost element for newly constructed
20 facilities shall be based upon projected budgets. The
21 annually established payment rate shall take effect on July 1
22 in 1984 and subsequent years. No rate increase and no update
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1 for inflation shall be provided on or after July 1, 1994 and
2 before July 1, 2003, unless specifically provided for in this
3 Section.
4 For facilities licensed by the Department of Public
5 Health under the Nursing Home Care Act as Intermediate Care
6 for the Developmentally Disabled facilities or Long Term Care
7 for Under Age 22 facilities, the rates taking effect on July
8 1, 1998 shall include an increase of 3%. For facilities
9 licensed by the Department of Public Health under the Nursing
10 Home Care Act as Skilled Nursing facilities or Intermediate
11 Care facilities, the rates taking effect on July 1, 1998
12 shall include an increase of 3% plus $1.10 per resident-day,
13 as defined by the Department.
14 For facilities licensed by the Department of Public
15 Health under the Nursing Home Care Act as Intermediate Care
16 for the Developmentally Disabled facilities or Long Term Care
17 for Under Age 22 facilities, the rates taking effect on July
18 1, 1999 shall include an increase of 1.6% plus $3.00 per
19 resident-day, as defined by the Department. For facilities
20 licensed by the Department of Public Health under the Nursing
21 Home Care Act as Skilled Nursing facilities or Intermediate
22 Care facilities, the rates taking effect on July 1, 1999
23 shall include an increase of 1.6% and, for services provided
24 on or after October 1, 1999, shall be increased by $4.00 per
25 resident-day, as defined by the Department.
26 For facilities licensed by the Department of Public
27 Health under the Nursing Home Care Act as Intermediate Care
28 for the Developmentally Disabled facilities or Long Term Care
29 for Under Age 22 facilities, the rates taking effect on July
30 1, 2000 shall include an increase of 2.5% per resident-day,
31 as defined by the Department. For facilities licensed by the
32 Department of Public Health under the Nursing Home Care Act
33 as Skilled Nursing facilities or Intermediate Care
34 facilities, the rates taking effect on July 1, 2000 shall
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1 include an increase of 2.5% per resident-day, as defined by
2 the Department.
3 For facilities licensed by the Department of Public
4 Health under the Nursing Home Care Act as skilled nursing
5 facilities or intermediate care facilities, a new payment
6 methodology must be implemented for the nursing component of
7 the rate effective July 1, 2004 2003. The Department of
8 Public Aid shall develop the new payment methodology using
9 the Minimum Data Set (MDS) as the instrument to collect
10 information concerning nursing home resident condition
11 necessary to compute the rate. The Department of Public Aid
12 shall develop the new payment methodology to meet the unique
13 needs of Illinois nursing home residents while remaining
14 subject to the appropriations provided by the General
15 Assembly. A transition period from the payment methodology in
16 effect on June 30, 2004 2003 to the payment methodology in
17 effect on July 1, 2004 2003 shall be provided for a period
18 not exceeding 2 years after implementation of the new payment
19 methodology as follows:
20 (A) For a facility that would receive a lower
21 nursing component rate per patient day under the new
22 system than the facility received effective on the date
23 immediately preceding the date that the Department
24 implements the new payment methodology, the nursing
25 component rate per patient day for the facility shall be
26 held at the level in effect on the date immediately
27 preceding the date that the Department implements the new
28 payment methodology until a higher nursing component rate
29 of reimbursement is achieved by that facility.
30 (B) For a facility that would receive a higher
31 nursing component rate per patient day under the payment
32 methodology in effect on July 1, 2004 2003 than the
33 facility received effective on the date immediately
34 preceding the date that the Department implements the new
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1 payment methodology, the nursing component rate per
2 patient day for the facility shall be adjusted.
3 (C) Notwithstanding paragraphs (A) and (B), the
4 nursing component rate per patient day for the facility
5 shall be adjusted subject to appropriations provided by
6 the General Assembly.
7 For facilities licensed by the Department of Public
8 Health under the Nursing Home Care Act as Intermediate Care
9 for the Developmentally Disabled facilities or Long Term Care
10 for Under Age 22 facilities, the rates taking effect on March
11 1, 2001 shall include a statewide increase of 7.85%, as
12 defined by the Department.
13 For facilities licensed by the Department of Public
14 Health under the Nursing Home Care Act as Intermediate Care
15 for the Developmentally Disabled facilities or Long Term Care
16 for Under Age 22 facilities, the rates taking effect on April
17 1, 2002 shall include a statewide increase of 2.0%, as
18 defined by the Department. This increase terminates on July
19 1, 2002; beginning July 1, 2002 these rates are reduced to
20 the level of the rates in effect on March 31, 2002, as
21 defined by the Department.
22 For facilities licensed by the Department of Public
23 Health under the Nursing Home Care Act as skilled nursing
24 facilities or intermediate care facilities, the rates taking
25 effect on July 1, 2001, and each subsequent year thereafter,
26 shall be computed using the most recent cost reports on file
27 with the Department of Public Aid no later than April 1,
28 2000, updated for inflation to January 1, 2001. For rates
29 effective July 1, 2001 only, rates shall be the greater of
30 the rate computed for July 1, 2001 or the rate effective on
31 June 30, 2001.
32 Notwithstanding any other provision of this Section, for
33 facilities licensed by the Department of Public Health under
34 the Nursing Home Care Act as skilled nursing facilities or
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1 intermediate care facilities, the Illinois Department shall
2 determine by rule the rates taking effect on July 1, 2002,
3 which shall be 5.9% less than the rates in effect on June 30,
4 2002.
5 Rates established effective each July 1 shall govern
6 payment for services rendered throughout that fiscal year,
7 except that rates established on July 1, 1996 shall be
8 increased by 6.8% for services provided on or after January
9 1, 1997. Such rates will be based upon the rates calculated
10 for the year beginning July 1, 1990, and for subsequent years
11 thereafter until June 30, 2001 shall be based on the facility
12 cost reports for the facility fiscal year ending at any point
13 in time during the previous calendar year, updated to the
14 midpoint of the rate year. The cost report shall be on file
15 with the Department no later than April 1 of the current rate
16 year. Should the cost report not be on file by April 1, the
17 Department shall base the rate on the latest cost report
18 filed by each skilled care facility and intermediate care
19 facility, updated to the midpoint of the current rate year.
20 In determining rates for services rendered on and after July
21 1, 1985, fixed time shall not be computed at less than zero.
22 The Department shall not make any alterations of regulations
23 which would reduce any component of the Medicaid rate to a
24 level below what that component would have been utilizing in
25 the rate effective on July 1, 1984.
26 (2) Shall take into account the actual costs incurred by
27 facilities in providing services for recipients of skilled
28 nursing and intermediate care services under the medical
29 assistance program.
30 (3) Shall take into account the medical and
31 psycho-social characteristics and needs of the patients.
32 (4) Shall take into account the actual costs incurred by
33 facilities in meeting licensing and certification standards
34 imposed and prescribed by the State of Illinois, any of its
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1 political subdivisions or municipalities and by the U.S.
2 Department of Health and Human Services pursuant to Title XIX
3 of the Social Security Act.
4 The Department of Public Aid shall develop precise
5 standards for payments to reimburse nursing facilities for
6 any utilization of appropriate rehabilitative personnel for
7 the provision of rehabilitative services which is authorized
8 by federal regulations, including reimbursement for services
9 provided by qualified therapists or qualified assistants, and
10 which is in accordance with accepted professional practices.
11 Reimbursement also may be made for utilization of other
12 supportive personnel under appropriate supervision.
13 (Source: P.A. 91-24, eff. 7-1-99; 91-712, eff. 7-1-00; 92-10,
14 eff. 6-11-01; 92-31, eff. 6-28-01; 92-597, eff. 6-28-02;
15 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; revised 9-20-02.)
16 Section 99. Effective date. This Act takes effect upon
17 becoming law.".