Sen. Louis S. Viverito

Filed: 11/2/2005

 

 


 

 


 
09400HB3478sam001 LRB094 08651 DRJ 50094 a

1
AMENDMENT TO HOUSE BILL 3478

2     AMENDMENT NO. ______. Amend House Bill 3478 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 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

 

 

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1 effect on July 1 in 1984 and subsequent years. No rate increase
2 and no update for inflation shall be provided on or after July
3 1, 1994 and before July 1, 2006, unless specifically provided
4 for in this Section. The changes made by this amendatory Act of
5 the 93rd General Assembly extending the duration of the
6 prohibition against a rate increase or update for inflation are
7 effective retroactive to July 1, 2004.
8     For facilities licensed by the Department of Public Health
9 under the Nursing Home Care Act as Intermediate Care for the
10 Developmentally Disabled facilities or Long Term Care for Under
11 Age 22 facilities, the rates taking effect on July 1, 1998
12 shall include an increase of 3%. 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, 1998 shall include an
16 increase of 3% plus $1.10 per resident-day, as defined by the
17 Department. For facilities licensed by the Department of Public
18 Health under the Nursing Home Care Act as Intermediate Care
19 Facilities for the Developmentally Disabled or Long Term Care
20 for Under Age 22 facilities, the rates taking effect on January
21 1, 2006 shall include an increase of 3%.
22     For facilities licensed by the Department of Public Health
23 under the Nursing Home Care Act as Intermediate Care for the
24 Developmentally Disabled facilities or Long Term Care for Under
25 Age 22 facilities, the rates taking effect on July 1, 1999
26 shall include an increase of 1.6% plus $3.00 per resident-day,
27 as defined by the Department. For facilities licensed by the
28 Department of Public Health under the Nursing Home Care Act as
29 Skilled Nursing facilities or Intermediate Care facilities,
30 the rates taking effect on July 1, 1999 shall include an
31 increase of 1.6% and, for services provided on or after October
32 1, 1999, shall be increased by $4.00 per resident-day, as
33 defined by the Department.
34     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 July 1, 2000
4 shall include an increase of 2.5% per resident-day, as defined
5 by the Department. For facilities licensed by the Department of
6 Public Health under the Nursing Home Care Act as Skilled
7 Nursing facilities or Intermediate Care facilities, the rates
8 taking effect on July 1, 2000 shall include an increase of 2.5%
9 per resident-day, as defined by the Department.
10     For facilities licensed by the Department of Public Health
11 under the Nursing Home Care Act as skilled nursing facilities
12 or intermediate care facilities, a new payment methodology must
13 be implemented for the nursing component of the rate effective
14 July 1, 2003. The Department of Public Aid shall develop the
15 new payment methodology using the Minimum Data Set (MDS) as the
16 instrument to collect information concerning nursing home
17 resident condition necessary to compute the rate. The
18 Department of Public Aid shall develop the new payment
19 methodology to meet the unique needs of Illinois nursing home
20 residents while remaining subject to the appropriations
21 provided by the General Assembly. A transition period from the
22 payment methodology in effect on June 30, 2003 to the payment
23 methodology in effect on July 1, 2003 shall be provided for a
24 period not exceeding 3 years after implementation of the new
25 payment methodology as follows:
26         (A) For a facility that would receive a lower nursing
27     component rate per patient day under the new system than
28     the facility received effective on the date immediately
29     preceding the date that the Department implements the new
30     payment methodology, the nursing component rate per
31     patient day for the facility shall be held at the level in
32     effect on the date immediately preceding the date that the
33     Department implements the new payment methodology until a
34     higher nursing component rate of reimbursement is achieved

 

 

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1     by that facility.
2         (B) For a facility that would receive a higher nursing
3     component rate per patient day under the payment
4     methodology in effect on July 1, 2003 than the facility
5     received effective on the date immediately preceding the
6     date that the Department implements the new payment
7     methodology, the nursing component rate per patient day for
8     the facility shall be adjusted.
9         (C) Notwithstanding paragraphs (A) and (B), the
10     nursing component rate per patient day for the facility
11     shall be adjusted subject to appropriations provided by the
12     General Assembly.
13     For facilities licensed by the Department of Public Health
14 under the Nursing Home Care Act as Intermediate Care for the
15 Developmentally Disabled facilities or Long Term Care for Under
16 Age 22 facilities, the rates taking effect on March 1, 2001
17 shall include a statewide increase of 7.85%, as defined by the
18 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 April 1, 2002
23 shall include a statewide increase of 2.0%, as defined by the
24 Department. This increase terminates on July 1, 2002; beginning
25 July 1, 2002 these rates are reduced to the level of the rates
26 in effect on March 31, 2002, as defined by the Department.
27     For facilities licensed by the Department of Public Health
28 under the Nursing Home Care Act as skilled nursing facilities
29 or intermediate care facilities, the rates taking effect on
30 July 1, 2001 shall be computed using the most recent cost
31 reports on file with the Department of Public Aid no later than
32 April 1, 2000, updated for inflation to January 1, 2001. For
33 rates effective July 1, 2001 only, rates shall be the greater
34 of the rate computed for July 1, 2001 or the rate effective on

 

 

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1 June 30, 2001.
2     Notwithstanding any other provision of this Section, for
3 facilities licensed by the Department of Public Health under
4 the Nursing Home Care Act as skilled nursing facilities or
5 intermediate care facilities, the Illinois Department shall
6 determine by rule the rates taking effect on July 1, 2002,
7 which shall be 5.9% less than the rates in effect on June 30,
8 2002.
9     Notwithstanding any other provision of this Section, for
10 facilities licensed by the Department of Public Health under
11 the Nursing Home Care Act as skilled nursing facilities or
12 intermediate care facilities, if the payment methodologies
13 required under Section 5A-12 and the waiver granted under 42
14 CFR 433.68 are approved by the United States Centers for
15 Medicare and Medicaid Services, the rates taking effect on July
16 1, 2004 shall be 3.0% greater than the rates in effect on June
17 30, 2004. These rates shall take effect only upon approval and
18 implementation of the payment methodologies required under
19 Section 5A-12.
20     Notwithstanding any other provisions of this Section, for
21 facilities licensed by the Department of Public Health under
22 the Nursing Home Care Act as skilled nursing facilities or
23 intermediate care facilities, the rates taking effect on
24 January 1, 2005 shall be 3% more than the rates in effect on
25 December 31, 2004.
26     For facilities licensed by the Department of Public Health
27 under the Nursing Home Care Act as Intermediate Care for the
28 Developmentally Disabled facilities or as long-term care
29 facilities for residents under 22 years of age, the rates
30 taking effect on July 1, 2003 shall include a statewide
31 increase of 4%, as defined by the Department.
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, effective January 1, 2005,
2 facility rates shall be increased by the difference between (i)
3 a facility's per diem property, liability, and malpractice
4 insurance costs as reported in the cost report filed with the
5 Department of Public Aid and used to establish rates effective
6 July 1, 2001 and (ii) those same costs as reported in the
7 facility's 2002 cost report. These costs shall be passed
8 through to the facility without caps or limitations, except for
9 adjustments required under normal auditing procedures.
10     Rates established effective each July 1 shall govern
11 payment for services rendered throughout that fiscal year,
12 except that rates established on July 1, 1996 shall be
13 increased by 6.8% for services provided on or after January 1,
14 1997. Such rates will be based upon the rates calculated for
15 the year beginning July 1, 1990, and for subsequent years
16 thereafter until June 30, 2001 shall be based on the facility
17 cost reports for the facility fiscal year ending at any point
18 in time during the previous calendar year, updated to the
19 midpoint of the rate year. The cost report shall be on file
20 with the Department no later than April 1 of the current rate
21 year. Should the cost report not be on file by April 1, the
22 Department shall base the rate on the latest cost report filed
23 by each skilled care facility and intermediate care facility,
24 updated to the midpoint of the current rate year. In
25 determining rates for services rendered on and after July 1,
26 1985, fixed time shall not be computed at less than zero. The
27 Department shall not make any alterations of regulations which
28 would reduce any component of the Medicaid rate to a level
29 below what that component would have been utilizing in the rate
30 effective on July 1, 1984.
31     (2) Shall take into account the actual costs incurred by
32 facilities in providing services for recipients of skilled
33 nursing and intermediate care services under the medical
34 assistance program.

 

 

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1     (3) Shall take into account the medical and psycho-social
2 characteristics and needs of the patients.
3     (4) Shall take into account the actual costs incurred by
4 facilities in meeting licensing and certification standards
5 imposed and prescribed by the State of Illinois, any of its
6 political subdivisions or municipalities and by the U.S.
7 Department of Health and Human Services pursuant to Title XIX
8 of the Social Security Act.
9     The Department of Public Aid shall develop precise
10 standards for payments to reimburse nursing facilities for any
11 utilization of appropriate rehabilitative personnel for the
12 provision of rehabilitative services which is authorized by
13 federal regulations, including reimbursement for services
14 provided by qualified therapists or qualified assistants, and
15 which is in accordance with accepted professional practices.
16 Reimbursement also may be made for utilization of other
17 supportive personnel under appropriate supervision.
18 (Source: P.A. 93-20, eff. 6-20-03; 93-649, eff. 1-8-04; 93-659,
19 eff. 2-3-04; 93-841, eff. 7-30-04; 93-1087, eff. 2-28-05;
20 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; revised 8-9-05.)
 
21     Section 99. Effective date. This Act takes effect upon
22 becoming law.".