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1 | AN ACT concerning public aid.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Illinois Public Aid Code is amended by | ||||||
5 | changing Sections 5-4.2, 5-5.4, 5B-2, 5B-4, and 5B-8 as | ||||||
6 | follows:
| ||||||
7 | (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
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8 | Sec. 5-4.2. Ambulance services payments. | ||||||
9 | (a) For
ambulance
services provided to a recipient of aid | ||||||
10 | under this Article on or after
January 1, 1993, the Illinois | ||||||
11 | Department shall reimburse ambulance service
providers at | ||||||
12 | rates calculated in accordance with this Section. It is the | ||||||
13 | intent
of the General Assembly to provide adequate | ||||||
14 | reimbursement for ambulance
services so as to ensure adequate | ||||||
15 | access to services for recipients of aid
under this Article and | ||||||
16 | to provide appropriate incentives to ambulance service
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17 | providers to provide services in an efficient and | ||||||
18 | cost-effective manner. Thus,
it is the intent of the General | ||||||
19 | Assembly that the Illinois Department implement
a | ||||||
20 | reimbursement system for ambulance services that, to the extent | ||||||
21 | practicable
and subject to the availability of funds | ||||||
22 | appropriated by the General Assembly
for this purpose, is | ||||||
23 | consistent with the payment principles of Medicare. To
ensure |
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1 | uniformity between the payment principles of Medicare and | ||||||
2 | Medicaid, the
Illinois Department shall follow, to the extent | ||||||
3 | necessary and practicable and
subject to the availability of | ||||||
4 | funds appropriated by the General Assembly for
this purpose, | ||||||
5 | the statutes, laws, regulations, policies, procedures,
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6 | principles, definitions, guidelines, and manuals used to | ||||||
7 | determine the amounts
paid to ambulance service providers under | ||||||
8 | Title XVIII of the Social Security
Act (Medicare).
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9 | (b) For ambulance services provided to a recipient of aid | ||||||
10 | under this Article
on or after January 1, 1996, the Illinois | ||||||
11 | Department shall reimburse ambulance
service providers based | ||||||
12 | upon the actual distance traveled if a natural
disaster, | ||||||
13 | weather conditions, road repairs, or traffic congestion | ||||||
14 | necessitates
the use of a
route other than the most direct | ||||||
15 | route.
| ||||||
16 | (c) For purposes of this Section, "ambulance services" | ||||||
17 | includes medical
transportation services provided by means of | ||||||
18 | an ambulance, medi-car, service
car, or
taxi.
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19 | (c-1) For purposes of this Section, "ground ambulance | ||||||
20 | service" means medical transportation services that are | ||||||
21 | described as ground ambulance services by the Centers for | ||||||
22 | Medicare and Medicaid Services and provided in a vehicle that | ||||||
23 | is licensed as an ambulance by the Illinois Department of | ||||||
24 | Public Health pursuant to the Emergency Medical Services (EMS) | ||||||
25 | Systems Act. | ||||||
26 | (c-2) For purposes of this Section, "ground ambulance |
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1 | service provider" means a vehicle service provider as described | ||||||
2 | in the Emergency Medical Services (EMS) Systems Act that | ||||||
3 | operates licensed ambulances for the purpose of providing | ||||||
4 | emergency ambulance services, or non-emergency ambulance | ||||||
5 | services, or both. For purposes of this Section, this includes | ||||||
6 | both ambulance providers and ambulance suppliers as described | ||||||
7 | by the Centers for Medicare and Medicaid Services. | ||||||
8 | (d) This Section does not prohibit separate billing by | ||||||
9 | ambulance service
providers for oxygen furnished while | ||||||
10 | providing advanced life support
services.
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11 | (e) Beginning with services rendered on or after July 1, | ||||||
12 | 2008, all providers of non-emergency medi-car and service car | ||||||
13 | transportation must certify that the driver and employee | ||||||
14 | attendant, as applicable, have completed a safety program | ||||||
15 | approved by the Department to protect both the patient and the | ||||||
16 | driver, prior to transporting a patient.
The provider must | ||||||
17 | maintain this certification in its records. The provider shall | ||||||
18 | produce such documentation upon demand by the Department or its | ||||||
19 | representative. Failure to produce documentation of such | ||||||
20 | training shall result in recovery of any payments made by the | ||||||
21 | Department for services rendered by a non-certified driver or | ||||||
22 | employee attendant. Medi-car and service car providers must | ||||||
23 | maintain legible documentation in their records of the driver | ||||||
24 | and, as applicable, employee attendant that actually | ||||||
25 | transported the patient. Providers must recertify all drivers | ||||||
26 | and employee attendants every 3 years.
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1 | Notwithstanding the requirements above, any public | ||||||
2 | transportation provider of medi-car and service car | ||||||
3 | transportation that receives federal funding under 49 U.S.C. | ||||||
4 | 5307 and 5311 need not certify its drivers and employee | ||||||
5 | attendants under this Section, since safety training is already | ||||||
6 | federally mandated.
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7 | (f) With respect to any policy or program administered by | ||||||
8 | the Department or its agent regarding approval of non-emergency | ||||||
9 | medical transportation by ground ambulance service providers, | ||||||
10 | including, but not limited to, the Non-Emergency | ||||||
11 | Transportation Services Prior Approval Program (NETSPAP), the | ||||||
12 | Department shall establish by rule a process by which ground | ||||||
13 | ambulance service providers of non-emergency medical | ||||||
14 | transportation may appeal any decision by the Department or its | ||||||
15 | agent for which no denial was received prior to the time of | ||||||
16 | transport that either (i) denies a request for approval for | ||||||
17 | payment of non-emergency transportation by means of ground | ||||||
18 | ambulance service or (ii) grants a request for approval of | ||||||
19 | non-emergency transportation by means of ground ambulance | ||||||
20 | service at a level of service that entitles the ground | ||||||
21 | ambulance service provider to a lower level of compensation | ||||||
22 | from the Department than the ground ambulance service provider | ||||||
23 | would have received as compensation for the level of service | ||||||
24 | requested. The rule shall be established within 12 months after | ||||||
25 | the effective date of this amendatory Act of the 97th General | ||||||
26 | Assembly and shall provide that, for any decision rendered by |
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1 | the Department or its agent on or after the date the rule takes | ||||||
2 | effect, the ground ambulance service provider shall have 60 | ||||||
3 | days from the date the decision is received to file an appeal. | ||||||
4 | The rule established by the Department shall be, insofar as is | ||||||
5 | practical, consistent with the Illinois Administrative | ||||||
6 | Procedure Act. The Director's decision on an appeal under this | ||||||
7 | Section shall be a final administrative decision subject to | ||||||
8 | review under the Administrative Review Law. | ||||||
9 | (Source: P.A. 95-501, eff. 8-28-07.)
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10 | (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4) | ||||||
11 | Sec. 5-5.4. Standards of Payment - Department of Healthcare | ||||||
12 | and Family Services.
The Department of Healthcare and Family | ||||||
13 | Services shall develop standards of payment of
nursing facility | ||||||
14 | and ICF/DD services in facilities providing such services
under | ||||||
15 | this Article which:
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16 | (1) Provide for the determination of a facility's payment
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17 | for nursing facility or ICF/DD services on a prospective basis.
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18 | The amount of the payment rate for all nursing facilities | ||||||
19 | certified by the
Department of Public Health under the MR/DD | ||||||
20 | Community Care Act or the Nursing Home Care Act as Intermediate
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21 | Care for the Developmentally Disabled facilities, Long Term | ||||||
22 | Care for Under Age
22 facilities, Skilled Nursing facilities, | ||||||
23 | or Intermediate Care facilities
under the
medical assistance | ||||||
24 | program shall be prospectively established annually on the
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25 | basis of historical, financial, and statistical data |
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1 | reflecting actual costs
from prior years, which shall be | ||||||
2 | applied to the current rate year and updated
for inflation, | ||||||
3 | except that the capital cost element for newly constructed
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4 | facilities shall be based upon projected budgets. The annually | ||||||
5 | established
payment rate shall take effect on July 1 in 1984 | ||||||
6 | and subsequent years. No rate
increase and no
update for | ||||||
7 | inflation shall be provided on or after July 1, 1994 and before
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8 | July 1, 2012, unless specifically provided for in this
Section.
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9 | The changes made by Public Act 93-841
extending the duration of | ||||||
10 | the prohibition against a rate increase or update for inflation | ||||||
11 | are effective retroactive to July 1, 2004.
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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
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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%.
For facilities | ||||||
26 | licensed by the Department of Public Health under the Nursing |
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1 | Home Care Act as Intermediate Care Facilities for the | ||||||
2 | Developmentally Disabled or Long Term Care for Under Age 22 | ||||||
3 | facilities, the rates taking effect on January 1, 2009 shall | ||||||
4 | include an increase sufficient to provide a $0.50 per hour wage | ||||||
5 | increase for non-executive staff. | ||||||
6 | For facilities licensed by the Department of Public Health | ||||||
7 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
8 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
9 | Age 22 facilities, the rates taking
effect on July 1, 1999 | ||||||
10 | shall include an increase of 1.6% plus $3.00 per
resident-day, | ||||||
11 | as defined by the Department. For facilities licensed by the
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12 | Department of Public Health under the Nursing Home Care Act as | ||||||
13 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
14 | the rates taking effect on July 1,
1999 shall include an | ||||||
15 | increase of 1.6% and, for services provided on or after
October | ||||||
16 | 1, 1999, shall be increased by $4.00 per resident-day, as | ||||||
17 | defined by
the Department.
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18 | For facilities licensed by the Department of Public Health | ||||||
19 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
20 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
21 | Age 22 facilities, the rates taking
effect on July 1, 2000 | ||||||
22 | shall include an increase of 2.5% per resident-day,
as defined | ||||||
23 | by the Department. For facilities licensed by the Department of
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24 | Public Health under the Nursing Home Care Act as Skilled | ||||||
25 | Nursing facilities or
Intermediate Care facilities, the rates | ||||||
26 | taking effect on July 1, 2000 shall
include an increase of 2.5% |
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1 | per resident-day, as defined by the Department.
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2 | For facilities licensed by the Department of Public Health | ||||||
3 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
4 | or intermediate care
facilities, a new payment methodology must | ||||||
5 | be implemented for the nursing
component of the rate effective | ||||||
6 | July 1, 2003. The Department of Public Aid
(now Healthcare and | ||||||
7 | Family Services) shall develop the new payment methodology | ||||||
8 | using the Minimum Data Set
(MDS) as the instrument to collect | ||||||
9 | information concerning nursing home
resident condition | ||||||
10 | necessary to compute the rate. The Department
shall develop the | ||||||
11 | new payment methodology to meet the unique needs of
Illinois | ||||||
12 | nursing home residents while remaining subject to the | ||||||
13 | appropriations
provided by the General Assembly.
A transition | ||||||
14 | period from the payment methodology in effect on June 30, 2003
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15 | to the payment methodology in effect on July 1, 2003 shall be | ||||||
16 | provided for a
period not exceeding 3 years and 184 days after | ||||||
17 | implementation of the new payment
methodology as follows:
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18 | (A) For a facility that would receive a lower
nursing | ||||||
19 | component rate per patient day under the new system than | ||||||
20 | the facility
received
effective on the date immediately | ||||||
21 | preceding the date that the Department
implements the new | ||||||
22 | payment methodology, the nursing component rate per | ||||||
23 | patient
day for the facility
shall be held at
the level in | ||||||
24 | effect on the date immediately preceding the date that the
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25 | Department implements the new payment methodology until a | ||||||
26 | higher nursing
component rate of
reimbursement is achieved |
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1 | by that
facility.
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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.
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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.
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19 | Notwithstanding any other provision of this Section, for | ||||||
20 | facilities licensed by the Department of Public Health under | ||||||
21 | the
Nursing Home Care Act as skilled nursing facilities or | ||||||
22 | intermediate care
facilities, except facilities participating | ||||||
23 | in the Department's demonstration program pursuant to the | ||||||
24 | provisions of Title 77, Part 300, Subpart T of the Illinois | ||||||
25 | Administrative Code, the numerator of the ratio used by the | ||||||
26 | Department of Healthcare and Family Services to compute the |
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1 | rate payable under this Section using the Minimum Data Set | ||||||
2 | (MDS) methodology shall incorporate the following annual | ||||||
3 | amounts as the additional funds appropriated to the Department | ||||||
4 | specifically to pay for rates based on the MDS nursing | ||||||
5 | component methodology in excess of the funding in effect on | ||||||
6 | December 31, 2006: | ||||||
7 | (i) For rates taking effect January 1, 2007, | ||||||
8 | $60,000,000. | ||||||
9 | (ii) For rates taking effect January 1, 2008, | ||||||
10 | $110,000,000. | ||||||
11 | (iii) For rates taking effect January 1, 2009, | ||||||
12 | $194,000,000. | ||||||
13 | (iv) For rates taking effect April 1, 2011, or the | ||||||
14 | first day of the month that begins at least 45 days after | ||||||
15 | the effective date of this amendatory Act of the 96th | ||||||
16 | General Assembly, $416,500,000 or an amount as may be | ||||||
17 | necessary to complete the transition to the MDS methodology | ||||||
18 | for the nursing component of the rate. Increased payments | ||||||
19 | under this item (iv) are not due and payable, however, | ||||||
20 | until (i) the methodologies described in this paragraph are | ||||||
21 | approved by the federal government in an appropriate State | ||||||
22 | Plan amendment and (ii) the assessment imposed by Section | ||||||
23 | 5B-2 of this Code is determined to be a permissible tax | ||||||
24 | under Title XIX of the Social Security Act. | ||||||
25 | Notwithstanding any other provision of this Section, for | ||||||
26 | facilities licensed by the Department of Public Health under |
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1 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
2 | intermediate care facilities, the support component of the | ||||||
3 | rates taking effect on January 1, 2008 shall be computed using | ||||||
4 | the most recent cost reports on file with the Department of | ||||||
5 | Healthcare and Family Services no later than April 1, 2005, | ||||||
6 | updated for inflation to January 1, 2006. | ||||||
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 April 1, 2002 | ||||||
11 | shall include a statewide increase of 2.0%, as
defined by the | ||||||
12 | Department.
This increase terminates on July 1, 2002;
beginning | ||||||
13 | July 1, 2002 these rates are reduced to the level of the rates
| ||||||
14 | in effect on March 31, 2002, as defined by the Department.
| ||||||
15 | For facilities licensed by the Department of Public Health | ||||||
16 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
17 | or intermediate care
facilities, the rates taking effect on | ||||||
18 | July 1, 2001 shall be computed using the most recent cost | ||||||
19 | reports
on file with the Department of Public Aid no later than | ||||||
20 | April 1, 2000,
updated for inflation to January 1, 2001. For | ||||||
21 | rates effective July 1, 2001
only, rates shall be the greater | ||||||
22 | of the rate computed for July 1, 2001
or the rate effective on | ||||||
23 | June 30, 2001.
| ||||||
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 |
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1 | intermediate care facilities, the Illinois
Department shall | ||||||
2 | determine by rule the rates taking effect on July 1, 2002,
| ||||||
3 | which shall be 5.9% less than the rates in effect on June 30, | ||||||
4 | 2002.
| ||||||
5 | Notwithstanding any other provision of this Section, for | ||||||
6 | facilities
licensed by the Department of Public Health under | ||||||
7 | the Nursing Home Care Act as
skilled nursing
facilities or | ||||||
8 | intermediate care facilities, if the payment methodologies | ||||||
9 | required under Section 5A-12 and the waiver granted under 42 | ||||||
10 | CFR 433.68 are approved by the United States Centers for | ||||||
11 | Medicare and Medicaid Services, the rates taking effect on July | ||||||
12 | 1, 2004 shall be 3.0% greater than the rates in effect on June | ||||||
13 | 30, 2004. These rates shall take
effect only upon approval and
| ||||||
14 | implementation of the payment methodologies required under | ||||||
15 | Section 5A-12.
| ||||||
16 | Notwithstanding any other provisions of this Section, for | ||||||
17 | facilities licensed by the Department of Public Health under | ||||||
18 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
19 | intermediate care facilities, the rates taking effect on | ||||||
20 | January 1, 2005 shall be 3% more than the rates in effect on | ||||||
21 | December 31, 2004.
| ||||||
22 | Notwithstanding any other provision of this Section, for | ||||||
23 | facilities licensed by the Department of Public Health under | ||||||
24 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
25 | intermediate care facilities, effective January 1, 2009, the | ||||||
26 | per diem support component of the rates effective on January 1, |
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1 | 2008, computed using the most recent cost reports on file with | ||||||
2 | the Department of Healthcare and Family Services no later than | ||||||
3 | April 1, 2005, updated for inflation to January 1, 2006, shall | ||||||
4 | be increased to the amount that would have been derived using | ||||||
5 | standard Department of Healthcare and Family Services methods, | ||||||
6 | procedures, and inflators. | ||||||
7 | Notwithstanding any other provisions of this Section, for | ||||||
8 | facilities licensed by the Department of Public Health under | ||||||
9 | the Nursing Home Care Act as intermediate care facilities that | ||||||
10 | are federally defined as Institutions for Mental Disease, a | ||||||
11 | socio-development component rate equal to 6.6% of the | ||||||
12 | facility's nursing component rate as of January 1, 2006 shall | ||||||
13 | be established and paid effective July 1, 2006. The | ||||||
14 | socio-development component of the rate shall be increased by a | ||||||
15 | factor of 2.53 on the first day of the month that begins at | ||||||
16 | least 45 days after January 11, 2008 (the effective date of | ||||||
17 | Public Act 95-707). As of August 1, 2008, the socio-development | ||||||
18 | component rate shall be equal to 6.6% of the facility's nursing | ||||||
19 | component rate as of January 1, 2006, multiplied by a factor of | ||||||
20 | 3.53. For services provided on or after April 1, 2011, or the | ||||||
21 | first day of the month that begins at least 45 days after the | ||||||
22 | effective date of this amendatory Act of the 96th General | ||||||
23 | Assembly, whichever is later, the Illinois Department may by | ||||||
24 | rule adjust these socio-development component rates, and may | ||||||
25 | use different adjustment methodologies for those facilities | ||||||
26 | participating, and those not participating, in the Illinois |
| |||||||
| |||||||
1 | Department's demonstration program pursuant to the provisions | ||||||
2 | of Title 77, Part 300, Subpart T of the Illinois Administrative | ||||||
3 | Code, but in no case may such rates be diminished below those | ||||||
4 | in effect on August 1, 2008.
| ||||||
5 | For facilities
licensed
by the
Department of Public Health | ||||||
6 | under the Nursing Home Care Act as Intermediate
Care for
the | ||||||
7 | Developmentally Disabled facilities or as long-term care | ||||||
8 | facilities for
residents under 22 years of age, the rates | ||||||
9 | taking effect on July 1,
2003 shall
include a statewide | ||||||
10 | increase of 4%, as defined by the Department.
| ||||||
11 | For facilities licensed by the Department of Public Health | ||||||
12 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
13 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
14 | Age 22 facilities, the rates taking
effect on the first day of | ||||||
15 | the month that begins at least 45 days after the effective date | ||||||
16 | of this amendatory Act of the 95th General Assembly shall | ||||||
17 | include a statewide increase of 2.5%, as
defined by the | ||||||
18 | Department. | ||||||
19 | Notwithstanding any other provision of this Section, for | ||||||
20 | facilities licensed by the Department of Public Health under | ||||||
21 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
22 | intermediate care facilities, effective January 1, 2005, | ||||||
23 | facility rates shall be increased by the difference between (i) | ||||||
24 | a facility's per diem property, liability, and malpractice | ||||||
25 | insurance costs as reported in the cost report filed with the | ||||||
26 | Department of Public Aid and used to establish rates effective |
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| |||||||
1 | July 1, 2001 and (ii) those same costs as reported in the | ||||||
2 | facility's 2002 cost report. These costs shall be passed | ||||||
3 | through to the facility without caps or limitations, except for | ||||||
4 | adjustments required under normal auditing procedures.
| ||||||
5 | Rates established effective each July 1 shall govern | ||||||
6 | payment
for services rendered throughout that fiscal year, | ||||||
7 | except that rates
established on July 1, 1996 shall be | ||||||
8 | increased by 6.8% for services
provided on or after January 1, | ||||||
9 | 1997. Such rates will be based
upon the rates calculated for | ||||||
10 | the year beginning July 1, 1990, and for
subsequent years | ||||||
11 | thereafter until June 30, 2001 shall be based on the
facility | ||||||
12 | cost reports
for the facility fiscal year ending at any point | ||||||
13 | in time during the previous
calendar year, updated to the | ||||||
14 | midpoint of the rate year. The cost report
shall be on file | ||||||
15 | with the Department no later than April 1 of the current
rate | ||||||
16 | year. Should the cost report not be on file by April 1, the | ||||||
17 | Department
shall base the rate on the latest cost report filed | ||||||
18 | by each skilled care
facility and intermediate care facility, | ||||||
19 | updated to the midpoint of the
current rate year. In | ||||||
20 | determining rates for services rendered on and after
July 1, | ||||||
21 | 1985, fixed time shall not be computed at less than zero. The
| ||||||
22 | Department shall not make any alterations of regulations which | ||||||
23 | would reduce
any component of the Medicaid rate to a level | ||||||
24 | below what that component would
have been utilizing in the rate | ||||||
25 | effective on July 1, 1984.
| ||||||
26 | (2) Shall take into account the actual costs incurred by |
| |||||||
| |||||||
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 Healthcare and Family Services
shall | ||||||
13 | develop precise standards for
payments to reimburse nursing | ||||||
14 | facilities for any utilization of
appropriate rehabilitative | ||||||
15 | personnel for the provision of rehabilitative
services which is | ||||||
16 | authorized by federal regulations, including
reimbursement for | ||||||
17 | services provided by qualified therapists or qualified
| ||||||
18 | assistants, and which is in accordance with accepted | ||||||
19 | professional
practices. Reimbursement also may be made for | ||||||
20 | utilization of other
supportive personnel under appropriate | ||||||
21 | supervision.
| ||||||
22 | The Department shall develop enhanced payments to offset | ||||||
23 | the additional costs incurred by a
facility serving exceptional | ||||||
24 | need residents and shall allocate at least $8,000,000 of the | ||||||
25 | funds
collected from the assessment established by Section 5B-2 | ||||||
26 | of this Code for such payments. For
the purpose of this |
| |||||||
| |||||||
1 | Section, "exceptional needs" means, but need not be limited to, | ||||||
2 | ventilator care, tracheotomy care,
bariatric care, complex | ||||||
3 | wound care, and traumatic brain injury care. The enhanced | ||||||
4 | payments for exceptional need residents under this paragraph | ||||||
5 | are not due and payable, however, until (i) the methodologies | ||||||
6 | described in this paragraph are approved by the federal | ||||||
7 | government in an appropriate State Plan amendment and (ii) the | ||||||
8 | assessment imposed by Section 5B-2 of this Code is determined | ||||||
9 | to be a permissible tax under Title XIX of the Social Security | ||||||
10 | Act. | ||||||
11 | (5) Beginning July 1, 2012 the methodologies for | ||||||
12 | reimbursement of nursing facility services as provided under | ||||||
13 | this Section 5-5.4 shall no longer be applicable for bills | ||||||
14 | payable for State fiscal years 2012 and thereafter. | ||||||
15 | (6) No payment increase under this Section for the MDS | ||||||
16 | methodology, exceptional care residents, or the | ||||||
17 | socio-development component rate established by Public Act | ||||||
18 | 96-1530 of the 96th General Assembly and funded by the | ||||||
19 | assessment imposed under Section 5B-2 of this Code shall be due | ||||||
20 | and payable until after the Department notifies the long-term | ||||||
21 | care providers, in writing, that the payment methodologies to | ||||||
22 | long-term care providers required under this Section have been | ||||||
23 | approved by the Centers for Medicare and Medicaid Services of | ||||||
24 | the U.S. Department of Health and Human Services and the | ||||||
25 | waivers under 42 CFR 433.68 for the assessment imposed by this | ||||||
26 | Section, if necessary, have been granted by the Centers for |
| |||||||
| |||||||
1 | Medicare and Medicaid Services of the U.S. Department of Health | ||||||
2 | and Human Services. Upon notification to the Department of | ||||||
3 | approval of the payment methodologies required under this | ||||||
4 | Section and the waivers granted under 42 CFR 433.68, all | ||||||
5 | increased payments otherwise due under this Section prior to | ||||||
6 | the date of notification shall be due and payable within 90 | ||||||
7 | days of the date federal approval is received. | ||||||
8 | (Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707, | ||||||
9 | eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09; | ||||||
10 | 96-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10; | ||||||
11 | 96-1530, eff. 2-16-11.)
| ||||||
12 | (305 ILCS 5/5B-2) (from Ch. 23, par. 5B-2)
| ||||||
13 | Sec. 5B-2. Assessment; no local authorization to tax.
| ||||||
14 | (a) For the privilege of engaging in the occupation of | ||||||
15 | long-term care
provider, beginning July 1, 2011 an assessment | ||||||
16 | is imposed upon each long-term care provider in an amount equal | ||||||
17 | to $6.07 times the number of occupied bed days due and payable | ||||||
18 | each month. Notwithstanding any provision of any other Act to | ||||||
19 | the
contrary, this assessment shall be construed as a tax, but | ||||||
20 | shall not be billed or passed on to any resident of a nursing | ||||||
21 | home operated by the nursing home provider may not be added
to | ||||||
22 | the charges of an individual's nursing home care that is paid | ||||||
23 | for in
whole, or in part, by a federal, State, or combined | ||||||
24 | federal-state medical
care program .
| ||||||
25 | (b) Nothing in this amendatory Act of 1992 shall be |
| |||||||
| |||||||
1 | construed to
authorize any home rule unit or other unit of | ||||||
2 | local government to license
for revenue or impose a tax or | ||||||
3 | assessment upon long-term care providers or
the occupation of | ||||||
4 | long-term care provider, or a tax or assessment measured
by the | ||||||
5 | income or earnings or occupied bed days of a long-term care | ||||||
6 | provider.
| ||||||
7 | (c) The assessment imposed by this Section shall not be due | ||||||
8 | and payable, however, until after the Department notifies the | ||||||
9 | long-term care providers, in writing, that the payment | ||||||
10 | methodologies to long-term care providers required under | ||||||
11 | Section 5-5.4 of this Code have been approved by the Centers | ||||||
12 | for Medicare and Medicaid Services of the U.S. Department of | ||||||
13 | Health and Human Services and the waivers under 42 CFR 433.68 | ||||||
14 | for the assessment imposed by this Section, if necessary, have | ||||||
15 | been granted by the Centers for Medicare and Medicaid Services | ||||||
16 | of the U.S. Department of Health and Human Services. | ||||||
17 | (Source: P.A. 96-1530, eff. 2-16-11.)
| ||||||
18 | (305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)
| ||||||
19 | Sec. 5B-4. Payment of assessment; penalty.
| ||||||
20 | (a) The assessment imposed by Section 5B-2 shall be due and | ||||||
21 | payable monthly, on the last State business day of the month | ||||||
22 | for occupied bed days reported for the preceding third month | ||||||
23 | prior to the month in which the tax is payable and due. A | ||||||
24 | facility that has delayed payment due to the State's failure to | ||||||
25 | reimburse for services rendered may request an extension on the |
| |||||||
| |||||||
1 | due date for payment pursuant to subsection (b) and shall pay | ||||||
2 | the assessment within 30 days of reimbursement by the | ||||||
3 | Department.
The Illinois Department may provide that county | ||||||
4 | nursing homes directed and
maintained pursuant to Section | ||||||
5 | 5-1005 of the Counties Code may meet their
assessment | ||||||
6 | obligation by certifying to the Illinois Department that county
| ||||||
7 | expenditures have been obligated for the operation of the | ||||||
8 | county nursing
home in an amount at least equal to the amount | ||||||
9 | of the assessment.
| ||||||
10 | (a-5) Each assessment payment shall be accompanied by an | ||||||
11 | assessment report to be completed by the long-term care | ||||||
12 | provider. A separate report shall be completed for each | ||||||
13 | long-term care facility in this State operated by a long-term | ||||||
14 | care provider. The report shall be in a form and manner | ||||||
15 | prescribed by the Illinois Department and shall at a minimum | ||||||
16 | provide for the reporting of the number of occupied bed days of | ||||||
17 | the long-term care facility for the reporting period and other | ||||||
18 | reasonable information the Illinois Department requires for | ||||||
19 | the administration of its responsibilities under this Code. To | ||||||
20 | the extent practicable, the Department shall coordinate the | ||||||
21 | assessment reporting requirements with other reporting | ||||||
22 | required of long-term care facilities. | ||||||
23 | (b) The Illinois Department is authorized to establish
| ||||||
24 | delayed payment schedules for long-term care providers that are
| ||||||
25 | unable to make assessment payments when due under this Section
| ||||||
26 | due to financial difficulties, as determined by the Illinois
|
| |||||||
| |||||||
1 | Department. The Illinois Department may not deny a request for | ||||||
2 | delay of payment of the assessment imposed under this Article | ||||||
3 | if the long-term care provider has not been paid for services | ||||||
4 | provided during the month on which the assessment is levied.
| ||||||
5 | (c) If a long-term care provider fails to pay the full
| ||||||
6 | amount of an assessment payment when due (including any | ||||||
7 | extensions
granted under subsection (b)), there shall, unless | ||||||
8 | waived by the
Illinois Department for reasonable cause, be | ||||||
9 | added to the
assessment imposed by Section 5B-2 a
penalty | ||||||
10 | assessment equal to the lesser of (i) 5% of the amount of
the | ||||||
11 | assessment payment not paid on or before the due date plus 5% | ||||||
12 | of the
portion thereof remaining unpaid on the last day of each | ||||||
13 | month
thereafter or (ii) 100% of the assessment payment amount | ||||||
14 | not paid on or
before the due date. For purposes of this | ||||||
15 | subsection, payments
will be credited first to unpaid | ||||||
16 | assessment payment amounts (rather than
to penalty or | ||||||
17 | interest), beginning with the most delinquent assessment | ||||||
18 | payments. Payment cycles of longer than 60 days shall be one | ||||||
19 | factor the Director takes into account in granting a waiver | ||||||
20 | under this Section.
| ||||||
21 | (c-5) If a long-term care provider fails to file its report | ||||||
22 | with payment, there shall, unless waived by the Illinois | ||||||
23 | Department for reasonable cause, be added to the assessment due | ||||||
24 | a penalty assessment equal to 25% of the assessment due. | ||||||
25 | (d) Nothing in this amendatory Act of 1993 shall be | ||||||
26 | construed to prevent
the Illinois Department from collecting |
| |||||||
| |||||||
1 | all amounts due under this Article
pursuant to an assessment | ||||||
2 | imposed before the effective date of this amendatory
Act of | ||||||
3 | 1993.
| ||||||
4 | (e) Nothing in this amendatory Act of the 96th General | ||||||
5 | Assembly shall be construed to prevent
the Illinois Department | ||||||
6 | from collecting all amounts due under this Code
pursuant to an | ||||||
7 | assessment, tax, fee, or penalty imposed before the effective | ||||||
8 | date of this amendatory
Act of the 96th General Assembly. | ||||||
9 | (f) No installment of the assessment imposed by Section | ||||||
10 | 5B-2 shall be due and payable until after the Department | ||||||
11 | notifies the long-term care providers, in writing, that the | ||||||
12 | payment methodologies to long-term care providers required | ||||||
13 | under Section 5-5.4 of this Code have been approved by the | ||||||
14 | Centers for Medicare and Medicaid Services of the U.S. | ||||||
15 | Department of Health and Human Services and the waivers under | ||||||
16 | 42 CFR 433.68 for the assessment imposed by this Section, if | ||||||
17 | necessary, have been granted by the Centers for Medicare and | ||||||
18 | Medicaid Services of the U.S. Department of Health and Human | ||||||
19 | Services. Upon notification to the Department of approval of | ||||||
20 | the payment methodologies required under Section 5-5.4 of this | ||||||
21 | Code and the waivers granted under 42 CFR 433.68, all | ||||||
22 | installments otherwise due under Section 5B-4 prior to the date | ||||||
23 | of notification shall be due and payable to the Department upon | ||||||
24 | written direction from the Department within 90 days after | ||||||
25 | issuance by the Comptroller of the payments required under | ||||||
26 | Section 5-5.4 of this Code. |
| |||||||
| |||||||
1 | (Source: P.A. 96-444, eff. 8-14-09; 96-1530, eff. 2-16-11.)
| ||||||
2 | (305 ILCS 5/5B-8) (from Ch. 23, par. 5B-8)
| ||||||
3 | Sec. 5B-8. Long-Term Care Provider Fund.
| ||||||
4 | (a) There is created in the State Treasury the Long-Term
| ||||||
5 | Care Provider Fund. Interest earned by the Fund shall be
| ||||||
6 | credited to the Fund. The Fund shall not be used to replace any
| ||||||
7 | moneys appropriated to the Medicaid program by the General | ||||||
8 | Assembly.
| ||||||
9 | (b) The Fund is created for the purpose of receiving and
| ||||||
10 | disbursing moneys in accordance with this Article. | ||||||
11 | Disbursements
from the Fund shall be made only as follows:
| ||||||
12 | (1) For payments to nursing
facilities, including | ||||||
13 | county nursing facilities but excluding
State-operated | ||||||
14 | facilities, under Title XIX of the Social Security
Act and | ||||||
15 | Article V of this Code.
| ||||||
16 | (2) For the reimbursement of moneys collected by the
| ||||||
17 | Illinois Department through error or mistake.
| ||||||
18 | (3) For payment of administrative expenses incurred by | ||||||
19 | the
Illinois Department or its agent in performing the | ||||||
20 | activities
authorized by this Article.
| ||||||
21 | (3.5) For reimbursement of expenses incurred by | ||||||
22 | long-term care facilities, and payment of administrative | ||||||
23 | expenses incurred by the Department of Public Health, in | ||||||
24 | relation to the conduct and analysis of background checks | ||||||
25 | for identified offenders under the Nursing Home Care Act.
|
| |||||||
| |||||||
1 | (4) For payments of any amounts that are reimbursable | ||||||
2 | to the
federal government for payments from this Fund that | ||||||
3 | are required
to be paid by State warrant.
| ||||||
4 | (5) For making transfers to the General Obligation Bond
| ||||||
5 | Retirement and Interest Fund, as those transfers are | ||||||
6 | authorized
in the proceedings authorizing debt under the | ||||||
7 | Short Term Borrowing Act,
but transfers made under this | ||||||
8 | paragraph (5) shall not exceed the
principal amount of debt | ||||||
9 | issued in anticipation of the receipt by
the State of | ||||||
10 | moneys to be deposited into the Fund.
| ||||||
11 | (6) For making transfers, at the direction of the | ||||||
12 | Director of the Governor's Office of Management and Budget | ||||||
13 | during each fiscal year beginning on or after July 1, 2011, | ||||||
14 | to other State funds in an annual amount of $20,000,000 of | ||||||
15 | the tax collected pursuant to this Article for the purpose | ||||||
16 | of enforcement of nursing home standards, support of the | ||||||
17 | ombudsman program, and efforts to expand home and | ||||||
18 | community-based services. No transfer under this paragraph | ||||||
19 | shall occur until (i) the payment methodologies created by | ||||||
20 | Public Act 96-1530 under Section 5-5.4 of this Code have | ||||||
21 | been approved by the Centers for Medicare and Medicaid | ||||||
22 | Services of the U.S. Department of Health and Human | ||||||
23 | Services and (ii) the assessment imposed by Section 5B-2 of | ||||||
24 | this Code is determined to be a permissible tax under Title | ||||||
25 | XIX of the Social Security Act. | ||||||
26 | Disbursements from the Fund, other than transfers made |
| |||||||
| |||||||
1 | pursuant to paragraphs (5) and (6) of this subsection, shall be | ||||||
2 | by
warrants drawn by the State Comptroller upon receipt of | ||||||
3 | vouchers
duly executed and certified by the Illinois | ||||||
4 | Department.
| ||||||
5 | (c) The Fund shall consist of the following:
| ||||||
6 | (1) All moneys collected or received by the Illinois
| ||||||
7 | Department from the long-term care provider assessment | ||||||
8 | imposed by
this Article.
| ||||||
9 | (2) All federal matching funds received by the Illinois
| ||||||
10 | Department as a result of expenditures made by the Illinois
| ||||||
11 | Department that are attributable to moneys deposited in the | ||||||
12 | Fund.
| ||||||
13 | (3) Any interest or penalty levied in conjunction with | ||||||
14 | the
administration of this Article.
| ||||||
15 | (4) (Blank).
| ||||||
16 | (5) All other monies received for the Fund from any | ||||||
17 | other source,
including interest earned thereon.
| ||||||
18 | (Source: P.A. 95-707, eff. 1-11-08; 96-1530, eff. 2-16-11.)
| ||||||
19 | Section 99. Effective date. This Act takes effect upon | ||||||
20 | becoming law. |