HB2220 Enrolled LRB093 07406 DRJ 07570 b

1     AN ACT in relation to public aid.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
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 payment
12 for skilled nursing and intermediate care services on a
13 prospective basis. The amount of the payment rate for all
14 nursing facilities certified by the Department of Public Health
15 under the Nursing Home Care Act as Intermediate Care for the
16 Developmentally Disabled facilities, Long Term Care for Under
17 Age 22 facilities, Skilled Nursing facilities, or Intermediate
18 Care facilities under the medical assistance program shall be
19 prospectively established annually on the basis of historical,
20 financial, and statistical data reflecting actual costs from
21 prior years, which shall be applied to the current rate year
22 and updated for inflation, except that the capital cost element
23 for newly constructed facilities shall be based upon projected
24 budgets. The annually established payment rate shall take
25 effect on July 1 in 1984 and subsequent years. No rate increase
26 and no update for inflation shall be provided on or after July
27 1, 1994 and before July 1, 2004, unless specifically provided
28 for in this Section.
29     For facilities licensed by the Department of Public Health
30 under the Nursing Home Care Act as Intermediate Care for the
31 Developmentally Disabled facilities or Long Term Care for Under
32 Age 22 facilities, the rates taking effect on July 1, 1998

 

 

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1 shall include an increase of 3%. For facilities licensed by the
2 Department of Public Health under the Nursing Home Care Act as
3 Skilled Nursing facilities or Intermediate Care facilities,
4 the rates taking effect on July 1, 1998 shall include an
5 increase of 3% plus $1.10 per resident-day, as defined by the
6 Department.
7     For facilities licensed by the Department of Public Health
8 under the Nursing Home Care Act as Intermediate Care for the
9 Developmentally Disabled facilities or Long Term Care for Under
10 Age 22 facilities, the rates taking effect on July 1, 1999
11 shall include an increase of 1.6% plus $3.00 per resident-day,
12 as defined by the Department. For facilities licensed by the
13 Department of Public Health under the Nursing Home Care Act as
14 Skilled Nursing facilities or Intermediate Care facilities,
15 the rates taking effect on July 1, 1999 shall include an
16 increase of 1.6% and, for services provided on or after October
17 1, 1999, shall be increased by $4.00 per resident-day, as
18 defined by the Department.
19     For facilities licensed by the Department of Public Health
20 under the Nursing Home Care Act as Intermediate Care for the
21 Developmentally Disabled facilities or Long Term Care for Under
22 Age 22 facilities, the rates taking effect on July 1, 2000
23 shall include an increase of 2.5% per resident-day, as defined
24 by the Department. For facilities licensed by the Department of
25 Public Health under the Nursing Home Care Act as Skilled
26 Nursing facilities or Intermediate Care facilities, the rates
27 taking effect on July 1, 2000 shall include an increase of 2.5%
28 per resident-day, as defined by the Department.
29     For facilities licensed by the Department of Public Health
30 under the Nursing Home Care Act as skilled nursing facilities
31 or intermediate care facilities, a new payment methodology must
32 be implemented for the nursing component of the rate effective
33 July 1, 2003. The Department of Public Aid shall develop the
34 new payment methodology using the Minimum Data Set (MDS) as the
35 instrument to collect information concerning nursing home
36 resident condition necessary to compute the rate. The

 

 

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1 Department of Public Aid shall develop the new payment
2 methodology to meet the unique needs of Illinois nursing home
3 residents while remaining subject to the appropriations
4 provided by the General Assembly. A transition period from the
5 payment methodology in effect on June 30, 2003 to the payment
6 methodology in effect on July 1, 2003 shall be provided for a
7 period not exceeding 2 years after implementation of the new
8 payment methodology as follows:
9         (A) For a facility that would receive a lower nursing
10     component rate per patient day under the new system than
11     the facility received effective on the date immediately
12     preceding the date that the Department implements the new
13     payment methodology, the nursing component rate per
14     patient day for the facility shall be held at the level in
15     effect on the date immediately preceding the date that the
16     Department implements the new payment methodology until a
17     higher nursing component rate of reimbursement is achieved
18     by that facility.
19         (B) For a facility that would receive a higher nursing
20     component rate per patient day under the payment
21     methodology in effect on July 1, 2003 than the facility
22     received effective on the date immediately preceding the
23     date that the Department implements the new payment
24     methodology, the nursing component rate per patient day for
25     the facility shall be adjusted.
26         (C) Notwithstanding paragraphs (A) and (B), the
27     nursing component rate per patient day for the facility
28     shall be adjusted subject to appropriations provided by the
29     General Assembly.
30     For facilities licensed by the Department of Public Health
31 under the Nursing Home Care Act as Intermediate Care for the
32 Developmentally Disabled facilities or Long Term Care for Under
33 Age 22 facilities, the rates taking effect on March 1, 2001
34 shall include a statewide increase of 7.85%, as defined by the
35 Department.
36     For facilities licensed by the Department of Public Health

 

 

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1 under the Nursing Home Care Act as Intermediate Care for the
2 Developmentally Disabled facilities or Long Term Care for Under
3 Age 22 facilities, the rates taking effect on April 1, 2002
4 shall include a statewide increase of 2.0%, as defined by the
5 Department. This increase terminates on July 1, 2002; beginning
6 July 1, 2002 these rates are reduced to the level of the rates
7 in effect on March 31, 2002, as defined by the Department.
8     For facilities licensed by the Department of Public Health
9 under the Nursing Home Care Act as skilled nursing facilities
10 or intermediate care facilities, the rates taking effect on
11 July 1, 2001 shall be computed using the most recent cost
12 reports on file with the Department of Public Aid no later than
13 April 1, 2000, updated for inflation to January 1, 2001. For
14 rates effective July 1, 2001 only, rates shall be the greater
15 of the rate computed for July 1, 2001 or the rate effective on
16 June 30, 2001.
17     Notwithstanding any other provision of this Section, for
18 facilities licensed by the Department of Public Health under
19 the Nursing Home Care Act as skilled nursing facilities or
20 intermediate care facilities, the Illinois Department shall
21 determine by rule the rates taking effect on July 1, 2002,
22 which shall be 5.9% less than the rates in effect on June 30,
23 2002.
24     Notwithstanding any other provision of this Section, for
25 facilities licensed by the Department of Public Health under
26 the Nursing Home Care Act as skilled nursing facilities or
27 intermediate care facilities, the Illinois Department shall
28 determine by rule the rates taking effect on July 1, 2003,
29 which shall be 3.0% less than the rates in effect on June 30,
30 2002. This rate shall take effect only upon approval and
31 implementation of the payment methodologies required under
32 Section 5A-12.
33     For facilities licensed by the Department of Public Health
34 under the Nursing Home Care Act as Intermediate Care for the
35 Developmentally Disabled facilities or as long-term care
36 facilities for residents under 22 years of age, the rates

 

 

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1 taking effect on July 1, 2003 shall include a statewide
2 increase of 4%, as defined by the Department.
3     Notwithstanding any other provision of this Section, for
4 facilities licensed by the Department of Public Health under
5 the Nursing Home Care Act as skilled nursing facilities or
6 intermediate care facilities, effective July 1, 2004, facility
7 rates shall be increased by the difference between (i) a
8 facility's per diem property, liability, and malpractice
9 insurance costs as reported in the cost report filed with the
10 Department of Public Aid and used to establish rates effective
11 July 1, 2001 and (ii) those same costs as reported in the
12 facility's 2002 cost report. These costs shall be passed
13 through to the facility without caps or limitations, except for
14 adjustments required under normal auditing procedures.
15     Rates established effective each July 1 shall govern
16 payment for services rendered throughout that fiscal year,
17 except that rates established on July 1, 1996 shall be
18 increased by 6.8% for services provided on or after January 1,
19 1997. Such rates will be based upon the rates calculated for
20 the year beginning July 1, 1990, and for subsequent years
21 thereafter until June 30, 2001 shall be based on the facility
22 cost reports for the facility fiscal year ending at any point
23 in time during the previous calendar year, updated to the
24 midpoint of the rate year. The cost report shall be on file
25 with the Department no later than April 1 of the current rate
26 year. Should the cost report not be on file by April 1, the
27 Department shall base the rate on the latest cost report filed
28 by each skilled care facility and intermediate care facility,
29 updated to the midpoint of the current rate year. In
30 determining rates for services rendered on and after July 1,
31 1985, fixed time shall not be computed at less than zero. The
32 Department shall not make any alterations of regulations which
33 would reduce any component of the Medicaid rate to a level
34 below what that component would have been utilizing in the rate
35 effective on July 1, 1984.
36     (2) Shall take into account the actual costs incurred by

 

 

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1 facilities in providing services for recipients of skilled
2 nursing and intermediate care services under the medical
3 assistance program.
4     (3) Shall take into account the medical and psycho-social
5 characteristics and needs of the patients.
6     (4) Shall take into account the actual costs incurred by
7 facilities in meeting licensing and certification standards
8 imposed and prescribed by the State of Illinois, any of its
9 political subdivisions or municipalities and by the U.S.
10 Department of Health and Human Services pursuant to Title XIX
11 of the Social Security Act.
12     The Department of Public Aid shall develop precise
13 standards for payments to reimburse nursing facilities for any
14 utilization of appropriate rehabilitative personnel for the
15 provision of rehabilitative services which is authorized by
16 federal regulations, including reimbursement for services
17 provided by qualified therapists or qualified assistants, and
18 which is in accordance with accepted professional practices.
19 Reimbursement also may be made for utilization of other
20 supportive personnel under appropriate supervision.
21 (Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597,
22 eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20,
23 eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, eff. 2-3-04; revised
24 2-3-04.)
 
25     Section 99. Effective date. This Act takes effect July 1,
26 2004.