093_SB1331sam001

 










                                     LRB093 10989 DRJ 14647 a

 1                    AMENDMENT TO SENATE BILL 1331

 2        AMENDMENT NO.     .  Amend Senate Bill 1331 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
 
                            -2-      LRB093 10989 DRJ 14647 a
 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        The  capital  cost  element  of  rates for all facilities
 5    licensed by the Department of Public Health under the Nursing
 6    Home Care Act  as  an  Intermediate  Care  Facility  for  the
 7    Developmentally  Disabled with a capacity of 100 or more beds
 8    that receive a permit for  a  replacement  facility  required
 9    under  Sections  5 and 13.1 of the Illinois Health Facilities
10    Planning Act after July 1, 1994 shall be increased, effective
11    July 1, 2003, to reimburse 100% of the permitted cost of  the
12    structure over the ensuing 78 months.
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 July
17    1, 1998 shall include an  increase  of  3%.   For  facilities
18    licensed by the Department of Public Health under the Nursing
19    Home  Care  Act as Skilled Nursing facilities or Intermediate
20    Care facilities, the rates taking  effect  on  July  1,  1998
21    shall  include an increase of 3% plus $1.10 per resident-day,
22    as defined by the Department.
23        For facilities  licensed  by  the  Department  of  Public
24    Health  under  the Nursing Home Care Act as Intermediate Care
25    for the Developmentally Disabled facilities or Long Term Care
26    for Under Age 22 facilities, the rates taking effect on  July
27    1,  1999  shall  include  an  increase of 1.6% plus $3.00 per
28    resident-day, as defined by the Department.   For  facilities
29    licensed by the Department of Public Health under the Nursing
30    Home  Care  Act as Skilled Nursing facilities or Intermediate
31    Care facilities, the rates taking  effect  on  July  1,  1999
32    shall  include an increase of 1.6% and, for services provided
33    on or after October 1, 1999, shall be increased by $4.00  per
34    resident-day, as defined by the Department.
 
                            -3-      LRB093 10989 DRJ 14647 a
 1        For  facilities  licensed  by  the  Department  of Public
 2    Health under the Nursing Home Care Act as  Intermediate  Care
 3    for the Developmentally Disabled facilities or Long Term Care
 4    for  Under Age 22 facilities, the rates taking effect on July
 5    1, 2000 shall include an increase of 2.5%  per  resident-day,
 6    as defined by the Department.  For facilities licensed by the
 7    Department  of  Public Health under the Nursing Home Care Act
 8    as  Skilled   Nursing   facilities   or   Intermediate   Care
 9    facilities,  the  rates  taking  effect on July 1, 2000 shall
10    include an increase of 2.5% per resident-day, as  defined  by
11    the Department.
12        For  facilities  licensed  by  the  Department  of Public
13    Health under the Nursing Home Care  Act  as  skilled  nursing
14    facilities  or  intermediate  care  facilities, a new payment
15    methodology must be implemented for the nursing component  of
16    the rate effective July 1, 2003. The Department of Public Aid
17    shall  develop  the new payment methodology using the Minimum
18    Data Set (MDS)  as  the  instrument  to  collect  information
19    concerning  nursing  home  resident  condition  necessary  to
20    compute  the rate. The Department of Public Aid shall develop
21    the new payment methodology  to  meet  the  unique  needs  of
22    Illinois  nursing  home  residents while remaining subject to
23    the  appropriations  provided  by  the  General  Assembly.  A
24    transition period from the payment methodology in  effect  on
25    June 30, 2003 to the payment methodology in effect on July 1,
26    2003  shall  be  provided  for a period not exceeding 2 years
27    after  implementation  of  the  new  payment  methodology  as
28    follows:
29             (A)  For a  facility  that  would  receive  a  lower
30        nursing  component  rate  per  patient  day under the new
31        system than the facility received effective on  the  date
32        immediately   preceding  the  date  that  the  Department
33        implements  the  new  payment  methodology,  the  nursing
34        component rate per patient day for the facility shall  be
 
                            -4-      LRB093 10989 DRJ 14647 a
 1        held  at  the  level  in  effect  on the date immediately
 2        preceding the date that the Department implements the new
 3        payment methodology until a higher nursing component rate
 4        of reimbursement is achieved by that facility.
 5             (B)  For a facility  that  would  receive  a  higher
 6        nursing  component rate per patient day under the payment
 7        methodology in effect on July 1, 2003 than  the  facility
 8        received  effective on the date immediately preceding the
 9        date that  the  Department  implements  the  new  payment
10        methodology,  the  nursing component rate per patient day
11        for the facility shall be adjusted.
12             (C)  Notwithstanding paragraphs  (A)  and  (B),  the
13        nursing  component  rate per patient day for the facility
14        shall be adjusted subject to appropriations  provided  by
15        the General Assembly.
16        For  facilities  licensed  by  the  Department  of Public
17    Health under the Nursing Home Care Act as  Intermediate  Care
18    for the Developmentally Disabled facilities or Long Term Care
19    for Under Age 22 facilities, the rates taking effect on March
20    1,  2001  shall  include  a  statewide  increase of 7.85%, as
21    defined by the Department.
22        For facilities  licensed  by  the  Department  of  Public
23    Health  under  the Nursing Home Care Act as Intermediate Care
24    for the Developmentally Disabled facilities or Long Term Care
25    for Under Age 22 facilities, the rates taking effect on April
26    1, 2002 shall  include  a  statewide  increase  of  2.0%,  as
27    defined  by  the Department. This increase terminates on July
28    1, 2002; beginning July 1, 2002 these rates  are  reduced  to
29    the  level  of  the  rates  in  effect  on March 31, 2002, as
30    defined by the Department.
31        For facilities  licensed  by  the  Department  of  Public
32    Health  under  the  Nursing  Home Care Act as skilled nursing
33    facilities or intermediate care facilities, the rates  taking
34    effect  on July 1, 2001, and each subsequent year thereafter,
 
                            -5-      LRB093 10989 DRJ 14647 a
 1    shall be computed using the most recent cost reports on  file
 2    with  the  Department  of  Public  Aid no later than April 1,
 3    2000, updated for inflation to January 1,  2001.   For  rates
 4    effective  July  1,  2001 only, rates shall be the greater of
 5    the rate computed for July 1, 2001 or the rate  effective  on
 6    June 30, 2001.
 7        Notwithstanding  any other provision of this Section, for
 8    facilities licensed by the Department of Public Health  under
 9    the  Nursing  Home  Care Act as skilled nursing facilities or
10    intermediate care facilities, the Illinois  Department  shall
11    determine  by  rule  the rates taking effect on July 1, 2002,
12    which shall be 5.9% less than the rates in effect on June 30,
13    2002.
14        Rates established effective  each  July  1  shall  govern
15    payment  for  services  rendered throughout that fiscal year,
16    except that rates  established  on  July  1,  1996  shall  be
17    increased  by  6.8% for services provided on or after January
18    1, 1997.  Such rates will be based upon the rates  calculated
19    for the year beginning July 1, 1990, and for subsequent years
20    thereafter until June 30, 2001 shall be based on the facility
21    cost reports for the facility fiscal year ending at any point
22    in  time  during  the  previous calendar year, updated to the
23    midpoint of the rate year.  The cost report shall be on  file
24    with the Department no later than April 1 of the current rate
25    year.   Should the cost report not be on file by April 1, the
26    Department shall base the rate  on  the  latest  cost  report
27    filed  by  each  skilled  care facility and intermediate care
28    facility, updated to the midpoint of the current  rate  year.
29    In  determining rates for services rendered on and after July
30    1, 1985, fixed time shall not be computed at less than  zero.
31    The  Department shall not make any alterations of regulations
32    which would reduce any component of the Medicaid  rate  to  a
33    level  below what that component would have been utilizing in
34    the rate effective on July 1, 1984.
 
                            -6-      LRB093 10989 DRJ 14647 a
 1        (2)  Shall take into account the actual costs incurred by
 2    facilities in providing services for  recipients  of  skilled
 3    nursing  and  intermediate  care  services  under the medical
 4    assistance program.
 5        (3)  Shall   take   into   account   the   medical    and
 6    psycho-social characteristics and needs of the patients.
 7        (4)  Shall take into account the actual costs incurred by
 8    facilities  in  meeting licensing and certification standards
 9    imposed and prescribed by the State of Illinois, any  of  its
10    political  subdivisions  or  municipalities  and  by the U.S.
11    Department of Health and Human Services pursuant to Title XIX
12    of the Social Security Act.
13        The  Department  of  Public  Aid  shall  develop  precise
14    standards for payments to reimburse  nursing  facilities  for
15    any  utilization  of appropriate rehabilitative personnel for
16    the provision of rehabilitative services which is  authorized
17    by  federal regulations, including reimbursement for services
18    provided by qualified therapists or qualified assistants, and
19    which is in accordance with accepted professional  practices.
20    Reimbursement  also  may  be  made  for  utilization of other
21    supportive personnel under appropriate supervision.
22    (Source: P.A. 91-24, eff. 7-1-99; 91-712, eff. 7-1-00; 92-10,
23    eff. 6-11-01; 92-31,  eff.  6-28-01;  92-597,  eff.  6-28-02;
24    92-651, eff. 7-11-02; 92-848, eff. 1-1-03; revised 9-20-02.)

25        Section  99.  Effective date.  This Act takes effect upon
26    becoming law.".