HB3207 EnrolledLRB097 10291 KTG 50497 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-5.4, 5B-2, and 5B-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 Healthcare
8and Family Services. The Department of Healthcare and Family
9Services shall develop standards of payment of nursing facility
10and ICF/DD services in facilities providing such services under
11this Article which:
12    (1) Provide for the determination of a facility's payment
13for nursing facility or ICF/DD services on a prospective basis.
14The amount of the payment rate for all nursing facilities
15certified by the Department of Public Health under the MR/DD
16Community Care Act or the Nursing Home Care Act as Intermediate
17Care for the Developmentally Disabled facilities, Long Term
18Care for Under Age 22 facilities, Skilled Nursing facilities,
19or Intermediate Care facilities under the medical assistance
20program shall be prospectively established annually on the
21basis of historical, financial, and statistical data
22reflecting actual costs from prior years, which shall be
23applied to the current rate year and updated for inflation,

 

 

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1except that the capital cost element for newly constructed
2facilities shall be based upon projected budgets. The annually
3established payment rate shall take effect on July 1 in 1984
4and subsequent years. No rate increase and no update for
5inflation shall be provided on or after July 1, 1994 and before
6July 1, 2012, unless specifically provided for in this Section.
7The changes made by Public Act 93-841 extending the duration of
8the prohibition against a rate increase or update for inflation
9are effective retroactive to July 1, 2004.
10    For facilities licensed by the Department of Public Health
11under the Nursing Home Care Act as Intermediate Care for the
12Developmentally Disabled facilities or Long Term Care for Under
13Age 22 facilities, the rates taking effect on July 1, 1998
14shall include an increase of 3%. For facilities licensed by the
15Department of Public Health under the Nursing Home Care Act as
16Skilled Nursing facilities or Intermediate Care facilities,
17the rates taking effect on July 1, 1998 shall include an
18increase of 3% plus $1.10 per resident-day, as defined by the
19Department. For facilities licensed by the Department of Public
20Health under the Nursing Home Care Act as Intermediate Care
21Facilities for the Developmentally Disabled or Long Term Care
22for Under Age 22 facilities, the rates taking effect on January
231, 2006 shall include an increase of 3%. For facilities
24licensed by the Department of Public Health under the Nursing
25Home Care Act as Intermediate Care Facilities for the
26Developmentally Disabled or Long Term Care for Under Age 22

 

 

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1facilities, the rates taking effect on January 1, 2009 shall
2include an increase sufficient to provide a $0.50 per hour wage
3increase for non-executive staff.
4    For facilities licensed by the Department of Public Health
5under the Nursing Home Care Act as Intermediate Care for the
6Developmentally Disabled facilities or Long Term Care for Under
7Age 22 facilities, the rates taking effect on July 1, 1999
8shall include an increase of 1.6% plus $3.00 per resident-day,
9as defined by the Department. For facilities licensed by the
10Department of Public Health under the Nursing Home Care Act as
11Skilled Nursing facilities or Intermediate Care facilities,
12the rates taking effect on July 1, 1999 shall include an
13increase of 1.6% and, for services provided on or after October
141, 1999, shall be increased by $4.00 per resident-day, as
15defined by the Department.
16    For facilities licensed by the Department of Public Health
17under the Nursing Home Care Act as Intermediate Care for the
18Developmentally Disabled facilities or Long Term Care for Under
19Age 22 facilities, the rates taking effect on July 1, 2000
20shall include an increase of 2.5% per resident-day, as defined
21by the Department. For facilities licensed by the Department of
22Public Health under the Nursing Home Care Act as Skilled
23Nursing facilities or Intermediate Care facilities, the rates
24taking effect on July 1, 2000 shall include an increase of 2.5%
25per resident-day, as defined by the Department.
26    For facilities licensed by the Department of Public Health

 

 

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1under the Nursing Home Care Act as skilled nursing facilities
2or intermediate care facilities, a new payment methodology must
3be implemented for the nursing component of the rate effective
4July 1, 2003. The Department of Public Aid (now Healthcare and
5Family Services) shall develop the new payment methodology
6using the Minimum Data Set (MDS) as the instrument to collect
7information concerning nursing home resident condition
8necessary to compute the rate. The Department shall develop the
9new payment methodology to meet the unique needs of Illinois
10nursing home residents while remaining subject to the
11appropriations provided by the General Assembly. A transition
12period from the payment methodology in effect on June 30, 2003
13to the payment methodology in effect on July 1, 2003 shall be
14provided for a period not exceeding 3 years and 184 days after
15implementation of the new payment methodology as follows:
16        (A) For a facility that would receive a lower nursing
17    component rate per patient day under the new system than
18    the facility received effective on the date immediately
19    preceding the date that the Department implements the new
20    payment methodology, the nursing component rate per
21    patient day for the facility shall be held at the level in
22    effect on the date immediately preceding the date that the
23    Department implements the new payment methodology until a
24    higher nursing component rate of reimbursement is achieved
25    by that facility.
26        (B) For a facility that would receive a higher nursing

 

 

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1    component rate per patient day under the payment
2    methodology in effect on July 1, 2003 than the facility
3    received effective on the date immediately preceding the
4    date that the Department implements the new payment
5    methodology, the nursing component rate per patient day for
6    the facility shall be adjusted.
7        (C) Notwithstanding paragraphs (A) and (B), the
8    nursing component rate per patient day for the facility
9    shall be adjusted subject to appropriations provided by the
10    General Assembly.
11    For facilities licensed by the Department of Public Health
12under the Nursing Home Care Act as Intermediate Care for the
13Developmentally Disabled facilities or Long Term Care for Under
14Age 22 facilities, the rates taking effect on March 1, 2001
15shall include a statewide increase of 7.85%, as defined by the
16Department.
17    Notwithstanding any other provision of this Section, for
18facilities licensed by the Department of Public Health under
19the Nursing Home Care Act as skilled nursing facilities or
20intermediate care facilities, except facilities participating
21in the Department's demonstration program pursuant to the
22provisions of Title 77, Part 300, Subpart T of the Illinois
23Administrative Code, the numerator of the ratio used by the
24Department of Healthcare and Family Services to compute the
25rate payable under this Section using the Minimum Data Set
26(MDS) methodology shall incorporate the following annual

 

 

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1amounts as the additional funds appropriated to the Department
2specifically to pay for rates based on the MDS nursing
3component methodology in excess of the funding in effect on
4December 31, 2006:
5        (i) For rates taking effect January 1, 2007,
6    $60,000,000.
7        (ii) For rates taking effect January 1, 2008,
8    $110,000,000.
9        (iii) For rates taking effect January 1, 2009,
10    $194,000,000.
11        (iv) For rates taking effect April 1, 2011, or the
12    first day of the month that begins at least 45 days after
13    the effective date of this amendatory Act of the 96th
14    General Assembly, $416,500,000 or an amount as may be
15    necessary to complete the transition to the MDS methodology
16    for the nursing component of the rate. Increased payments
17    under this item (iv) are not due and payable, however,
18    until (i) the methodologies described in this paragraph are
19    approved by the federal government in an appropriate State
20    Plan amendment and (ii) the assessment imposed by Section
21    5B-2 of this Code is determined to be a permissible tax
22    under Title XIX of the Social Security Act.
23    Notwithstanding any other provision of this Section, for
24facilities licensed by the Department of Public Health under
25the Nursing Home Care Act as skilled nursing facilities or
26intermediate care facilities, the support component of the

 

 

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1rates taking effect on January 1, 2008 shall be computed using
2the most recent cost reports on file with the Department of
3Healthcare and Family Services no later than April 1, 2005,
4updated for inflation to January 1, 2006.
5    For facilities licensed by the Department of Public Health
6under the Nursing Home Care Act as Intermediate Care for the
7Developmentally Disabled facilities or Long Term Care for Under
8Age 22 facilities, the rates taking effect on April 1, 2002
9shall include a statewide increase of 2.0%, as defined by the
10Department. This increase terminates on July 1, 2002; beginning
11July 1, 2002 these rates are reduced to the level of the rates
12in effect on March 31, 2002, as defined by the Department.
13    For facilities licensed by the Department of Public Health
14under the Nursing Home Care Act as skilled nursing facilities
15or intermediate care facilities, the rates taking effect on
16July 1, 2001 shall be computed using the most recent cost
17reports on file with the Department of Public Aid no later than
18April 1, 2000, updated for inflation to January 1, 2001. For
19rates effective July 1, 2001 only, rates shall be the greater
20of the rate computed for July 1, 2001 or the rate effective on
21June 30, 2001.
22    Notwithstanding any other provision of this Section, for
23facilities licensed by the Department of Public Health under
24the Nursing Home Care Act as skilled nursing facilities or
25intermediate care facilities, the Illinois Department shall
26determine by rule the rates taking effect on July 1, 2002,

 

 

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1which shall be 5.9% less than the rates in effect on June 30,
22002.
3    Notwithstanding any other provision of this Section, for
4facilities licensed by the Department of Public Health under
5the Nursing Home Care Act as skilled nursing facilities or
6intermediate care facilities, if the payment methodologies
7required under Section 5A-12 and the waiver granted under 42
8CFR 433.68 are approved by the United States Centers for
9Medicare and Medicaid Services, the rates taking effect on July
101, 2004 shall be 3.0% greater than the rates in effect on June
1130, 2004. These rates shall take effect only upon approval and
12implementation of the payment methodologies required under
13Section 5A-12.
14    Notwithstanding any other provisions of this Section, for
15facilities licensed by the Department of Public Health under
16the Nursing Home Care Act as skilled nursing facilities or
17intermediate care facilities, the rates taking effect on
18January 1, 2005 shall be 3% more than the rates in effect on
19December 31, 2004.
20    Notwithstanding any other provision of this Section, for
21facilities licensed by the Department of Public Health under
22the Nursing Home Care Act as skilled nursing facilities or
23intermediate care facilities, effective January 1, 2009, the
24per diem support component of the rates effective on January 1,
252008, computed using the most recent cost reports on file with
26the Department of Healthcare and Family Services no later than

 

 

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1April 1, 2005, updated for inflation to January 1, 2006, shall
2be increased to the amount that would have been derived using
3standard Department of Healthcare and Family Services methods,
4procedures, and inflators.
5    Notwithstanding any other provisions of this Section, for
6facilities licensed by the Department of Public Health under
7the Nursing Home Care Act as intermediate care facilities that
8are federally defined as Institutions for Mental Disease, a
9socio-development component rate equal to 6.6% of the
10facility's nursing component rate as of January 1, 2006 shall
11be established and paid effective July 1, 2006. The
12socio-development component of the rate shall be increased by a
13factor of 2.53 on the first day of the month that begins at
14least 45 days after January 11, 2008 (the effective date of
15Public Act 95-707). As of August 1, 2008, the socio-development
16component rate shall be equal to 6.6% of the facility's nursing
17component rate as of January 1, 2006, multiplied by a factor of
183.53. For services provided on or after April 1, 2011, or the
19first day of the month that begins at least 45 days after the
20effective date of this amendatory Act of the 96th General
21Assembly, whichever is later, the Illinois Department may by
22rule adjust these socio-development component rates, and may
23use different adjustment methodologies for those facilities
24participating, and those not participating, in the Illinois
25Department's demonstration program pursuant to the provisions
26of Title 77, Part 300, Subpart T of the Illinois Administrative

 

 

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1Code, but in no case may such rates be diminished below those
2in effect on August 1, 2008.
3    For facilities licensed by the Department of Public Health
4under the Nursing Home Care Act as Intermediate Care for the
5Developmentally Disabled facilities or as long-term care
6facilities for residents under 22 years of age, the rates
7taking effect on July 1, 2003 shall include a statewide
8increase of 4%, as defined by the Department.
9    For facilities licensed by the Department of Public Health
10under the Nursing Home Care Act as Intermediate Care for the
11Developmentally Disabled facilities or Long Term Care for Under
12Age 22 facilities, the rates taking effect on the first day of
13the month that begins at least 45 days after the effective date
14of this amendatory Act of the 95th General Assembly shall
15include a statewide increase of 2.5%, as defined by the
16Department.
17    Notwithstanding any other provision of this Section, for
18facilities licensed by the Department of Public Health under
19the Nursing Home Care Act as skilled nursing facilities or
20intermediate care facilities, effective January 1, 2005,
21facility rates shall be increased by the difference between (i)
22a facility's per diem property, liability, and malpractice
23insurance costs as reported in the cost report filed with the
24Department of Public Aid and used to establish rates effective
25July 1, 2001 and (ii) those same costs as reported in the
26facility's 2002 cost report. These costs shall be passed

 

 

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1through to the facility without caps or limitations, except for
2adjustments required under normal auditing procedures.
3    Rates established effective each July 1 shall govern
4payment for services rendered throughout that fiscal year,
5except that rates established on July 1, 1996 shall be
6increased by 6.8% for services provided on or after January 1,
71997. Such rates will be based upon the rates calculated for
8the year beginning July 1, 1990, and for subsequent years
9thereafter until June 30, 2001 shall be based on the facility
10cost reports for the facility fiscal year ending at any point
11in time during the previous calendar year, updated to the
12midpoint of the rate year. The cost report shall be on file
13with the Department no later than April 1 of the current rate
14year. Should the cost report not be on file by April 1, the
15Department shall base the rate on the latest cost report filed
16by each skilled care facility and intermediate care facility,
17updated to the midpoint of the current rate year. In
18determining rates for services rendered on and after July 1,
191985, fixed time shall not be computed at less than zero. The
20Department shall not make any alterations of regulations which
21would reduce any component of the Medicaid rate to a level
22below what that component would have been utilizing in the rate
23effective on July 1, 1984.
24    (2) Shall take into account the actual costs incurred by
25facilities in providing services for recipients of skilled
26nursing and intermediate care services under the medical

 

 

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1assistance program.
2    (3) Shall take into account the medical and psycho-social
3characteristics and needs of the patients.
4    (4) Shall take into account the actual costs incurred by
5facilities in meeting licensing and certification standards
6imposed and prescribed by the State of Illinois, any of its
7political subdivisions or municipalities and by the U.S.
8Department of Health and Human Services pursuant to Title XIX
9of the Social Security Act.
10    The Department of Healthcare and Family Services shall
11develop precise standards for payments to reimburse nursing
12facilities for any utilization of appropriate rehabilitative
13personnel for the provision of rehabilitative services which is
14authorized by federal regulations, including reimbursement for
15services provided by qualified therapists or qualified
16assistants, and which is in accordance with accepted
17professional practices. Reimbursement also may be made for
18utilization of other supportive personnel under appropriate
19supervision.
20    The Department shall develop enhanced payments to offset
21the additional costs incurred by a facility serving exceptional
22need residents and shall allocate at least $8,000,000 of the
23funds collected from the assessment established by Section 5B-2
24of this Code for such payments. For the purpose of this
25Section, "exceptional needs" means, but need not be limited to,
26ventilator care, tracheotomy care, bariatric care, complex

 

 

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1wound care, and traumatic brain injury care. The enhanced
2payments for exceptional need residents under this paragraph
3are not due and payable, however, until (i) the methodologies
4described in this paragraph are approved by the federal
5government in an appropriate State Plan amendment and (ii) the
6assessment imposed by Section 5B-2 of this Code is determined
7to be a permissible tax under Title XIX of the Social Security
8Act.
9    (5) Beginning July 1, 2012 the methodologies for
10reimbursement of nursing facility services as provided under
11this Section 5-5.4 shall no longer be applicable for bills
12payable for State fiscal years 2012 and thereafter.
13    (6) No payment increase under this Section for the MDS
14methodology, exceptional care residents, or the
15socio-development component rate established by Public Act
1696-1530 of the 96th General Assembly and funded by the
17assessment imposed under Section 5B-2 of this Code shall be due
18and payable until after the Department notifies the long-term
19care providers, in writing, that the payment methodologies to
20long-term care providers required under this Section have been
21approved by the Centers for Medicare and Medicaid Services of
22the U.S. Department of Health and Human Services and the
23waivers under 42 CFR 433.68 for the assessment imposed by this
24Section, if necessary, have been granted by the Centers for
25Medicare and Medicaid Services of the U.S. Department of Health
26and Human Services. Upon notification to the Department of

 

 

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1approval of the payment methodologies required under this
2Section and the waivers granted under 42 CFR 433.68, all
3increased payments otherwise due under this Section prior to
4the date of notification shall be due and payable within 90
5days of the date federal approval is received.
6(Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707,
7eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09;
896-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10;
996-1530, eff. 2-16-11.)
 
10    (305 ILCS 5/5B-2)  (from Ch. 23, par. 5B-2)
11    Sec. 5B-2. Assessment; no local authorization to tax.
12    (a) For the privilege of engaging in the occupation of
13long-term care provider, beginning July 1, 2011 an assessment
14is imposed upon each long-term care provider in an amount equal
15to $6.07 times the number of occupied bed days due and payable
16each month. Notwithstanding any provision of any other Act to
17the contrary, this assessment shall be construed as a tax, but
18may not be added to the charges of an individual's nursing home
19care that is paid for in whole, or in part, by a federal,
20State, or combined federal-state medical care program.
21    (b) Nothing in this amendatory Act of 1992 shall be
22construed to authorize any home rule unit or other unit of
23local government to license for revenue or impose a tax or
24assessment upon long-term care providers or the occupation of
25long-term care provider, or a tax or assessment measured by the

 

 

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1income or earnings or occupied bed days of a long-term care
2provider.
3    (c) The assessment imposed by this Section shall not be due
4and payable, however, until after the Department notifies the
5long-term care providers, in writing, that the payment
6methodologies to long-term care providers required under
7Section 5-5.4 of this Code have been approved by the Centers
8for Medicare and Medicaid Services of the U.S. Department of
9Health and Human Services and the waivers under 42 CFR 433.68
10for the assessment imposed by this Section, if necessary, have
11been granted by the Centers for Medicare and Medicaid Services
12of the U.S. Department of Health and Human Services.
13(Source: P.A. 96-1530, eff. 2-16-11.)
 
14    (305 ILCS 5/5B-4)  (from Ch. 23, par. 5B-4)
15    Sec. 5B-4. Payment of assessment; penalty.
16    (a) The assessment imposed by Section 5B-2 shall be due and
17payable monthly, on the last State business day of the month
18for occupied bed days reported for the preceding third month
19prior to the month in which the tax is payable and due. A
20facility that has delayed payment due to the State's failure to
21reimburse for services rendered may request an extension on the
22due date for payment pursuant to subsection (b) and shall pay
23the assessment within 30 days of reimbursement by the
24Department. The Illinois Department may provide that county
25nursing homes directed and maintained pursuant to Section

 

 

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15-1005 of the Counties Code may meet their assessment
2obligation by certifying to the Illinois Department that county
3expenditures have been obligated for the operation of the
4county nursing home in an amount at least equal to the amount
5of the assessment.
6    (a-5) Each assessment payment shall be accompanied by an
7assessment report to be completed by the long-term care
8provider. A separate report shall be completed for each
9long-term care facility in this State operated by a long-term
10care provider. The report shall be in a form and manner
11prescribed by the Illinois Department and shall at a minimum
12provide for the reporting of the number of occupied bed days of
13the long-term care facility for the reporting period and other
14reasonable information the Illinois Department requires for
15the administration of its responsibilities under this Code. To
16the extent practicable, the Department shall coordinate the
17assessment reporting requirements with other reporting
18required of long-term care facilities.
19    (b) The Illinois Department is authorized to establish
20delayed payment schedules for long-term care providers that are
21unable to make assessment payments when due under this Section
22due to financial difficulties, as determined by the Illinois
23Department. The Illinois Department may not deny a request for
24delay of payment of the assessment imposed under this Article
25if the long-term care provider has not been paid for services
26provided during the month on which the assessment is levied.

 

 

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1    (c) If a long-term care provider fails to pay the full
2amount of an assessment payment when due (including any
3extensions granted under subsection (b)), there shall, unless
4waived by the Illinois Department for reasonable cause, be
5added to the assessment imposed by Section 5B-2 a penalty
6assessment equal to the lesser of (i) 5% of the amount of the
7assessment payment not paid on or before the due date plus 5%
8of the portion thereof remaining unpaid on the last day of each
9month thereafter or (ii) 100% of the assessment payment amount
10not paid on or before the due date. For purposes of this
11subsection, payments will be credited first to unpaid
12assessment payment amounts (rather than to penalty or
13interest), beginning with the most delinquent assessment
14payments. Payment cycles of longer than 60 days shall be one
15factor the Director takes into account in granting a waiver
16under this Section.
17    (c-5) If a long-term care provider fails to file its report
18with payment, there shall, unless waived by the Illinois
19Department for reasonable cause, be added to the assessment due
20a penalty assessment equal to 25% of the assessment due.
21    (d) Nothing in this amendatory Act of 1993 shall be
22construed to prevent the Illinois Department from collecting
23all amounts due under this Article pursuant to an assessment
24imposed before the effective date of this amendatory Act of
251993.
26    (e) Nothing in this amendatory Act of the 96th General

 

 

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1Assembly shall be construed to prevent the Illinois Department
2from collecting all amounts due under this Code pursuant to an
3assessment, tax, fee, or penalty imposed before the effective
4date of this amendatory Act of the 96th General Assembly.
5    (f) No installment of the assessment imposed by Section
65B-2 shall be due and payable until after the Department
7notifies the long-term care providers, in writing, that the
8payment methodologies to long-term care providers required
9under Section 5-5.4 of this Code have been approved by the
10Centers for Medicare and Medicaid Services of the U.S.
11Department of Health and Human Services and the waivers under
1242 CFR 433.68 for the assessment imposed by this Section, if
13necessary, have been granted by the Centers for Medicare and
14Medicaid Services of the U.S. Department of Health and Human
15Services. Upon notification to the Department of approval of
16the payment methodologies required under Section 5-5.4 of this
17Code and the waivers granted under 42 CFR 433.68, all
18installments otherwise due under Section 5B-4 prior to the date
19of notification shall be due and payable to the Department upon
20written direction from the Department within 90 days after
21issuance by the Comptroller of the payments required under
22Section 5-5.4 of this Code.
23(Source: P.A. 96-444, eff. 8-14-09; 96-1530, eff. 2-16-11.)
 
24    Section 99. Effective date. This Act takes effect upon
25becoming law.