Human Services Committee

Filed: 10/25/2005

 

 


 

 


 
09400SB1620ham001 LRB094 05905 DRJ 49540 a

1
AMENDMENT TO SENATE BILL 1620

2     AMENDMENT NO. ______. Amend Senate Bill 1620 by replacing
3 the title with the following:
4     "AN ACT concerning public aid."; and
 
5 by replacing everything after the enacting clause with the
6 following:
 
7     "Section 5. The Illinois Public Aid Code is amended by
8 changing Section 5-5.4 as follows:
 
9     (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
10     Sec. 5-5.4. Standards of Payment - Department of Public
11 Aid. The Department of Public Aid shall develop standards of
12 payment of skilled nursing and intermediate care services in
13 facilities providing such services under this Article which:
14     (1) Provide for the determination of a facility's payment
15 for skilled nursing and intermediate care services on a
16 prospective basis. The amount of the payment rate for all
17 nursing facilities certified by the Department of Public Health
18 under the Nursing Home Care Act as Intermediate Care for the
19 Developmentally Disabled facilities, Long Term Care for Under
20 Age 22 facilities, Skilled Nursing facilities, or Intermediate
21 Care facilities under the medical assistance program shall be
22 prospectively established annually on the basis of historical,
23 financial, and statistical data reflecting actual costs from

 

 

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1 prior years, which shall be applied to the current rate year
2 and updated for inflation, except that the capital cost element
3 for newly constructed facilities shall be based upon projected
4 budgets. The annually established payment rate shall take
5 effect on July 1 in 1984 and subsequent years. No rate increase
6 and no update for inflation shall be provided on or after July
7 1, 1994 and before July 1, 2006, unless specifically provided
8 for in this Section. The changes made by this amendatory Act of
9 the 93rd General Assembly extending the duration of the
10 prohibition against a rate increase or update for inflation are
11 effective retroactive to July 1, 2004.
12     For facilities licensed by the Department of Public Health
13 under the Nursing Home Care Act as Intermediate Care for the
14 Developmentally Disabled facilities or Long Term Care for Under
15 Age 22 facilities, the rates taking effect on July 1, 1998
16 shall include an increase of 3%. For facilities licensed by the
17 Department of Public Health under the Nursing Home Care Act as
18 Skilled Nursing facilities or Intermediate Care facilities,
19 the rates taking effect on July 1, 1998 shall include an
20 increase of 3% plus $1.10 per resident-day, as defined by the
21 Department. For facilities licensed by the Department of Public
22 Health under the Nursing Home Care Act as Intermediate Care
23 Facilities for the Developmentally Disabled or Long Term Care
24 for Under Age 22 facilities, the rates taking effect on January
25 1, 2006 shall include an increase of 3%.
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 Long Term Care for Under
29 Age 22 facilities, the rates taking effect on July 1, 1999
30 shall include an increase of 1.6% plus $3.00 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 as
33 Skilled Nursing facilities or Intermediate Care facilities,
34 the rates taking effect on July 1, 1999 shall include an

 

 

09400SB1620ham001 - 3 - LRB094 05905 DRJ 49540 a

1 increase of 1.6% and, for services provided on or after October
2 1, 1999, shall be increased by $4.00 per resident-day, as
3 defined by the Department.
4     For facilities licensed by the Department of Public Health
5 under the Nursing Home Care Act as Intermediate Care for the
6 Developmentally Disabled facilities or Long Term Care for Under
7 Age 22 facilities, the rates taking effect on July 1, 2000
8 shall include an increase of 2.5% per resident-day, as defined
9 by the Department. For facilities licensed by the Department of
10 Public Health under the Nursing Home Care Act as Skilled
11 Nursing facilities or Intermediate Care facilities, the rates
12 taking effect on July 1, 2000 shall include an increase of 2.5%
13 per resident-day, as defined by the Department.
14     For facilities licensed by the Department of Public Health
15 under the Nursing Home Care Act as skilled nursing facilities
16 or intermediate care facilities, a new payment methodology must
17 be implemented for the nursing component of the rate effective
18 July 1, 2003. The Department of Public Aid shall develop the
19 new payment methodology using the Minimum Data Set (MDS) as the
20 instrument to collect information concerning nursing home
21 resident condition necessary to compute the rate. The
22 Department of Public Aid shall develop the new payment
23 methodology to meet the unique needs of Illinois nursing home
24 residents while remaining subject to the appropriations
25 provided by the General Assembly. A transition period from the
26 payment methodology in effect on June 30, 2003 to the payment
27 methodology in effect on July 1, 2003 shall be provided for a
28 period not exceeding 3 years after implementation of the new
29 payment methodology as follows:
30         (A) For a facility that would receive a lower nursing
31     component rate per patient day under the new system than
32     the facility received effective on the date immediately
33     preceding the date that the Department implements the new
34     payment methodology, the nursing component rate per

 

 

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1     patient day for the facility shall be held at the level in
2     effect on the date immediately preceding the date that the
3     Department implements the new payment methodology until a
4     higher nursing component rate of reimbursement is achieved
5     by that facility.
6         (B) For a facility that would receive a higher nursing
7     component rate per patient day under the payment
8     methodology in effect on July 1, 2003 than the facility
9     received effective on the date immediately preceding the
10     date that the Department implements the new payment
11     methodology, the nursing component rate per patient day for
12     the facility shall be adjusted.
13         (C) Notwithstanding paragraphs (A) and (B), the
14     nursing component rate per patient day for the facility
15     shall be adjusted subject to appropriations provided by the
16     General Assembly.
17     For facilities licensed by the Department of Public Health
18 under the Nursing Home Care Act as Intermediate Care for the
19 Developmentally Disabled facilities or Long Term Care for Under
20 Age 22 facilities, the rates taking effect on March 1, 2001
21 shall include a statewide increase of 7.85%, as defined by the
22 Department.
23     For facilities licensed by the Department of Public Health
24 under the Nursing Home Care Act as Intermediate Care for the
25 Developmentally Disabled facilities or Long Term Care for Under
26 Age 22 facilities, the rates taking effect on April 1, 2002
27 shall include a statewide increase of 2.0%, as defined by the
28 Department. This increase terminates on July 1, 2002; beginning
29 July 1, 2002 these rates are reduced to the level of the rates
30 in effect on March 31, 2002, as defined by the Department.
31     For facilities licensed by the Department of Public Health
32 under the Nursing Home Care Act as skilled nursing facilities
33 or intermediate care facilities, the rates taking effect on
34 July 1, 2001 shall be computed using the most recent cost

 

 

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1 reports on file with the Department of Public Aid no later than
2 April 1, 2000, updated for inflation to January 1, 2001. For
3 rates effective July 1, 2001 only, rates shall be the greater
4 of the rate computed for July 1, 2001 or the rate effective on
5 June 30, 2001.
6     Notwithstanding any other provision of this Section, for
7 facilities licensed by the Department of Public Health under
8 the Nursing Home Care Act as skilled nursing facilities or
9 intermediate care facilities, the Illinois Department shall
10 determine by rule the rates taking effect on July 1, 2002,
11 which shall be 5.9% less than the rates in effect on June 30,
12 2002.
13     Notwithstanding any other provision of this Section, for
14 facilities licensed by the Department of Public Health under
15 the Nursing Home Care Act as skilled nursing facilities or
16 intermediate care facilities, if the payment methodologies
17 required under Section 5A-12 and the waiver granted under 42
18 CFR 433.68 are approved by the United States Centers for
19 Medicare and Medicaid Services, the rates taking effect on July
20 1, 2004 shall be 3.0% greater than the rates in effect on June
21 30, 2004. These rates shall take effect only upon approval and
22 implementation of the payment methodologies required under
23 Section 5A-12.
24     Notwithstanding any other provisions 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 rates taking effect on
28 January 1, 2005 shall be 3% more than the rates in effect on
29 December 31, 2004.
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 as long-term care
33 facilities for residents under 22 years of age, the rates
34 taking effect on July 1, 2003 shall include a statewide

 

 

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1 increase of 4%, as defined by the Department.
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, effective January 1, 2005,
6 facility rates shall be increased by the difference between (i)
7 a facility's per diem property, liability, and malpractice
8 insurance costs as reported in the cost report filed with the
9 Department of Public Aid and used to establish rates effective
10 July 1, 2001 and (ii) those same costs as reported in the
11 facility's 2002 cost report. These costs shall be passed
12 through to the facility without caps or limitations, except for
13 adjustments required under normal auditing procedures.
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 1,
18 1997. Such rates will be based upon the rates calculated for
19 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 filed
27 by each skilled care facility and intermediate care facility,
28 updated to the midpoint of the current rate year. In
29 determining rates for services rendered on and after July 1,
30 1985, fixed time shall not be computed at less than zero. The
31 Department shall not make any alterations of regulations which
32 would reduce any component of the Medicaid rate to a level
33 below what that component would have been utilizing in the rate
34 effective on July 1, 1984.

 

 

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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 psycho-social
6 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 any
15 utilization of appropriate rehabilitative personnel for the
16 provision of rehabilitative services which is authorized by
17 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. 93-20, eff. 6-20-03; 93-649, eff. 1-8-04; 93-659,
23 eff. 2-3-04; 93-841, eff. 7-30-04; 93-1087, eff. 2-28-05;
24 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; revised 8-9-05.)
 
25     Section 99. Effective date. This Act takes effect upon
26 becoming law.".