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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 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 Healthcare | ||||||||||||||||||||||||
8 | and Family Services.
The Department of Healthcare and Family | ||||||||||||||||||||||||
9 | Services shall develop standards of payment of skilled
nursing | ||||||||||||||||||||||||
10 | and intermediate care services in facilities providing such | ||||||||||||||||||||||||
11 | services
under this Article which:
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12 | (1) Provide for the determination of a facility's payment
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13 | for skilled nursing and intermediate care services on a | ||||||||||||||||||||||||
14 | prospective basis.
The amount of the payment rate for all | ||||||||||||||||||||||||
15 | nursing facilities certified by the
Department of Public Health | ||||||||||||||||||||||||
16 | under the MR/DD Community Care Act or the Nursing Home Care Act | ||||||||||||||||||||||||
17 | as Intermediate
Care for the Developmentally Disabled | ||||||||||||||||||||||||
18 | facilities, Long Term Care for Under Age
22 facilities, Skilled | ||||||||||||||||||||||||
19 | Nursing facilities, or Intermediate Care facilities
under the
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20 | medical assistance program shall be prospectively established | ||||||||||||||||||||||||
21 | annually on the
basis of historical, financial, and statistical | ||||||||||||||||||||||||
22 | data reflecting actual costs
from prior years, which shall be | ||||||||||||||||||||||||
23 | applied to the current rate year and updated
for inflation, |
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1 | except that the capital cost element for newly constructed
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2 | facilities shall be based upon projected budgets. The annually | ||||||
3 | established
payment rate shall take effect on July 1 in 1984 | ||||||
4 | and subsequent years. No rate
increase and no
update for | ||||||
5 | inflation shall be provided on or after July 1, 1994 and before
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6 | July 1, 2011, unless specifically provided for in this
Section.
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7 | The changes made by Public Act 93-841
extending the duration of | ||||||
8 | the prohibition against a rate increase or update for inflation | ||||||
9 | are effective retroactive to July 1, 2004.
For facilities | ||||||
10 | licensed by the Department of Public Health under the Nursing | ||||||
11 | Home Care Act as Intermediate Care for the Developmentally | ||||||
12 | Disabled facilities or Long Term Care for Under Age 22 | ||||||
13 | facilities, the rates taking effect on July 1, 2011 shall | ||||||
14 | include a 3% increase. | ||||||
15 | For facilities licensed by the Department of Public Health | ||||||
16 | under the Nursing
Home Care Act as Intermediate Care for the | ||||||
17 | Developmentally Disabled facilities
or Long Term Care for Under | ||||||
18 | Age 22 facilities, the rates taking effect on July
1, 1998 | ||||||
19 | shall include an increase of 3%. For facilities licensed by the
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20 | Department of Public Health under the Nursing Home Care Act as | ||||||
21 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
22 | the rates taking effect on July 1,
1998 shall include an | ||||||
23 | increase of 3% plus $1.10 per resident-day, as defined by
the | ||||||
24 | Department. For facilities licensed by the Department of Public | ||||||
25 | Health under the Nursing Home Care Act as Intermediate Care | ||||||
26 | Facilities for the Developmentally Disabled or Long Term Care |
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1 | for Under Age 22 facilities, the rates taking effect on January | ||||||
2 | 1, 2006 shall include an increase of 3%.
For facilities | ||||||
3 | licensed by the Department of Public Health under the Nursing | ||||||
4 | Home Care Act as Intermediate Care Facilities for the | ||||||
5 | Developmentally Disabled or Long Term Care for Under Age 22 | ||||||
6 | facilities, the rates taking effect on January 1, 2009 shall | ||||||
7 | include an increase sufficient to provide a $0.50 per hour wage | ||||||
8 | increase for non-executive staff. | ||||||
9 | For facilities licensed by the Department of Public Health | ||||||
10 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
11 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
12 | Age 22 facilities, the rates taking
effect on July 1, 1999 | ||||||
13 | shall include an increase of 1.6% plus $3.00 per
resident-day, | ||||||
14 | as defined by the Department. For facilities licensed by the
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15 | Department of Public Health under the Nursing Home Care Act as | ||||||
16 | Skilled Nursing
facilities or Intermediate Care facilities, | ||||||
17 | the rates taking effect on July 1,
1999 shall include an | ||||||
18 | increase of 1.6% and, for services provided on or after
October | ||||||
19 | 1, 1999, shall be increased by $4.00 per resident-day, as | ||||||
20 | defined by
the Department.
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21 | For facilities licensed by the Department of Public Health | ||||||
22 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
23 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
24 | Age 22 facilities, the rates taking
effect on July 1, 2000 | ||||||
25 | shall include an increase of 2.5% per resident-day,
as defined | ||||||
26 | by the Department. For facilities licensed by the Department of
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1 | Public Health under the Nursing Home Care Act as Skilled | ||||||
2 | Nursing facilities or
Intermediate Care facilities, the rates | ||||||
3 | taking effect on July 1, 2000 shall
include an increase of 2.5% | ||||||
4 | per resident-day, as defined by the Department.
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5 | For facilities licensed by the Department of Public Health | ||||||
6 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
7 | or intermediate care
facilities, a new payment methodology must | ||||||
8 | be implemented for the nursing
component of the rate effective | ||||||
9 | July 1, 2003. The Department of Public Aid
(now Healthcare and | ||||||
10 | Family Services) shall develop the new payment methodology | ||||||
11 | using the Minimum Data Set
(MDS) as the instrument to collect | ||||||
12 | information concerning nursing home
resident condition | ||||||
13 | necessary to compute the rate. The Department
shall develop the | ||||||
14 | new payment methodology to meet the unique needs of
Illinois | ||||||
15 | nursing home residents while remaining subject to the | ||||||
16 | appropriations
provided by the General Assembly.
A transition | ||||||
17 | period from the payment methodology in effect on June 30, 2003
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18 | to the payment methodology in effect on July 1, 2003 shall be | ||||||
19 | provided for a
period not exceeding 3 years and 184 days after | ||||||
20 | implementation of the new payment
methodology as follows:
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21 | (A) For a facility that would receive a lower
nursing | ||||||
22 | component rate per patient day under the new system than | ||||||
23 | the facility
received
effective on the date immediately | ||||||
24 | preceding the date that the Department
implements the new | ||||||
25 | payment methodology, the nursing component rate per | ||||||
26 | patient
day for the facility
shall be held at
the level in |
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1 | effect on the date immediately preceding the date that the
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2 | Department implements the new payment methodology until a | ||||||
3 | higher nursing
component rate of
reimbursement is achieved | ||||||
4 | by that
facility.
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5 | (B) For a facility that would receive a higher nursing | ||||||
6 | component rate per
patient day under the payment | ||||||
7 | methodology in effect on July 1, 2003 than the
facility | ||||||
8 | received effective on the date immediately preceding the | ||||||
9 | date that the
Department implements the new payment | ||||||
10 | methodology, the nursing component rate
per patient day for | ||||||
11 | the facility shall be adjusted.
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12 | (C) Notwithstanding paragraphs (A) and (B), the | ||||||
13 | nursing component rate per
patient day for the facility | ||||||
14 | shall be adjusted subject to appropriations
provided by the | ||||||
15 | General Assembly.
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16 | For facilities licensed by the Department of Public Health | ||||||
17 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
18 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
19 | Age 22 facilities, the rates taking
effect on March 1, 2001 | ||||||
20 | shall include a statewide increase of 7.85%, as
defined by the | ||||||
21 | Department.
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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, the numerator of the ratio used | ||||||
26 | by the Department of Healthcare and Family Services to compute |
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1 | the 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 | 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, the support component of the | ||||||
17 | rates taking effect on January 1, 2008 shall be computed using | ||||||
18 | the most recent cost reports on file with the Department of | ||||||
19 | Healthcare and Family Services no later than April 1, 2005, | ||||||
20 | updated for inflation to January 1, 2006. | ||||||
21 | For facilities licensed by the Department of Public Health | ||||||
22 | under the
Nursing Home Care Act as Intermediate Care for the | ||||||
23 | Developmentally Disabled
facilities or Long Term Care for Under | ||||||
24 | Age 22 facilities, the rates taking
effect on April 1, 2002 | ||||||
25 | shall include a statewide increase of 2.0%, as
defined by the | ||||||
26 | Department.
This increase terminates on July 1, 2002;
beginning |
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1 | July 1, 2002 these rates are reduced to the level of the rates
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2 | in effect on March 31, 2002, as defined by the Department.
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3 | For facilities licensed by the Department of Public Health | ||||||
4 | under the
Nursing Home Care Act as skilled nursing facilities | ||||||
5 | or intermediate care
facilities, the rates taking effect on | ||||||
6 | July 1, 2001 shall be computed using the most recent cost | ||||||
7 | reports
on file with the Department of Public Aid no later than | ||||||
8 | April 1, 2000,
updated for inflation to January 1, 2001. For | ||||||
9 | rates effective July 1, 2001
only, rates shall be the greater | ||||||
10 | of the rate computed for July 1, 2001
or the rate effective on | ||||||
11 | June 30, 2001.
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12 | Notwithstanding any other provision of this Section, for | ||||||
13 | facilities
licensed by the Department of Public Health under | ||||||
14 | the Nursing Home Care Act
as skilled nursing facilities or | ||||||
15 | intermediate care facilities, the Illinois
Department shall | ||||||
16 | determine by rule the rates taking effect on July 1, 2002,
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17 | which shall be 5.9% less than the rates in effect on June 30, | ||||||
18 | 2002.
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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, if the payment methodologies | ||||||
23 | required under Section 5A-12 and the waiver granted under 42 | ||||||
24 | CFR 433.68 are approved by the United States Centers for | ||||||
25 | Medicare and Medicaid Services, the rates taking effect on July | ||||||
26 | 1, 2004 shall be 3.0% greater than the rates in effect on June |
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1 | 30, 2004. These rates shall take
effect only upon approval and
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2 | implementation of the payment methodologies required under | ||||||
3 | Section 5A-12.
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4 | Notwithstanding any other provisions of this Section, for | ||||||
5 | facilities licensed by the Department of Public Health under | ||||||
6 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
7 | intermediate care facilities, the rates taking effect on | ||||||
8 | January 1, 2005 shall be 3% more than the rates in effect on | ||||||
9 | December 31, 2004.
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10 | Notwithstanding any other provision of this Section, for | ||||||
11 | facilities licensed by the Department of Public Health under | ||||||
12 | the Nursing Home Care Act as skilled nursing facilities or | ||||||
13 | intermediate care facilities, effective January 1, 2009, the | ||||||
14 | per diem support component of the rates effective on January 1, | ||||||
15 | 2008, computed using the most recent cost reports on file with | ||||||
16 | the Department of Healthcare and Family Services no later than | ||||||
17 | April 1, 2005, updated for inflation to January 1, 2006, shall | ||||||
18 | be increased to the amount that would have been derived using | ||||||
19 | standard Department of Healthcare and Family Services methods, | ||||||
20 | procedures, and inflators. | ||||||
21 | Notwithstanding any other provisions of this Section, for | ||||||
22 | facilities licensed by the Department of Public Health under | ||||||
23 | the Nursing Home Care Act as intermediate care facilities that | ||||||
24 | are federally defined as Institutions for Mental Disease, a | ||||||
25 | socio-development component rate equal to 6.6% of the | ||||||
26 | facility's nursing component rate as of January 1, 2006 shall |
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1 | be established and paid effective July 1, 2006. The | ||||||
2 | socio-development component of the rate shall be increased by a | ||||||
3 | factor of 2.53 on the first day of the month that begins at | ||||||
4 | least 45 days after January 11, 2008 (the effective date of | ||||||
5 | Public Act 95-707). As of August 1, 2008, the socio-development | ||||||
6 | component rate shall be equal to 6.6% of the facility's nursing | ||||||
7 | component rate as of January 1, 2006, multiplied by a factor of | ||||||
8 | 3.53. The Illinois Department may by rule adjust these | ||||||
9 | socio-development component rates, but in no case may such | ||||||
10 | rates be diminished.
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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 as long-term care | ||||||
14 | facilities for
residents under 22 years of age, the rates | ||||||
15 | taking effect on July 1,
2003 shall
include a statewide | ||||||
16 | increase of 4%, as defined by the Department.
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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 the first day of | ||||||
21 | the month that begins at least 45 days after the effective date | ||||||
22 | of this amendatory Act of the 95th General Assembly shall | ||||||
23 | include a statewide increase of 2.5%, as
defined by the | ||||||
24 | Department. | ||||||
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, effective January 1, 2005, | ||||||
3 | facility rates shall be increased by the difference between (i) | ||||||
4 | a facility's per diem property, liability, and malpractice | ||||||
5 | insurance costs as reported in the cost report filed with the | ||||||
6 | Department of Public Aid and used to establish rates effective | ||||||
7 | July 1, 2001 and (ii) those same costs as reported in the | ||||||
8 | facility's 2002 cost report. These costs shall be passed | ||||||
9 | through to the facility without caps or limitations, except for | ||||||
10 | adjustments required under normal auditing procedures.
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11 | Rates established effective each July 1 shall govern | ||||||
12 | payment
for services rendered throughout that fiscal year, | ||||||
13 | except that rates
established on July 1, 1996 shall be | ||||||
14 | increased by 6.8% for services
provided on or after January 1, | ||||||
15 | 1997. Such rates will be based
upon the rates calculated for | ||||||
16 | the year beginning July 1, 1990, and for
subsequent years | ||||||
17 | thereafter until June 30, 2001 shall be based on the
facility | ||||||
18 | cost reports
for the facility fiscal year ending at any point | ||||||
19 | in time during the previous
calendar year, updated to the | ||||||
20 | midpoint of the rate year. The cost report
shall be on file | ||||||
21 | with the Department no later than April 1 of the current
rate | ||||||
22 | year. Should the cost report not be on file by April 1, the | ||||||
23 | Department
shall base the rate on the latest cost report filed | ||||||
24 | by each skilled care
facility and intermediate care facility, | ||||||
25 | updated to the midpoint of the
current rate year. In | ||||||
26 | determining rates for services rendered on and after
July 1, |
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1 | 1985, fixed time shall not be computed at less than zero. The
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2 | Department shall not make any alterations of regulations which | ||||||
3 | would reduce
any component of the Medicaid rate to a level | ||||||
4 | below what that component would
have been utilizing in the rate | ||||||
5 | effective on July 1, 1984.
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6 | (2) Shall take into account the actual costs incurred by | ||||||
7 | facilities
in providing services for recipients of skilled | ||||||
8 | nursing and intermediate
care services under the medical | ||||||
9 | assistance program.
| ||||||
10 | (3) Shall take into account the medical and psycho-social
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11 | characteristics and needs of the patients.
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12 | (4) Shall take into account the actual costs incurred by | ||||||
13 | facilities in
meeting licensing and certification standards | ||||||
14 | imposed and prescribed by the
State of Illinois, any of its | ||||||
15 | political subdivisions or municipalities and by
the U.S. | ||||||
16 | Department of Health and Human Services pursuant to Title XIX | ||||||
17 | of the
Social Security Act.
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18 | The Department of Healthcare and Family Services
shall | ||||||
19 | develop precise standards for
payments to reimburse nursing | ||||||
20 | facilities for any utilization of
appropriate rehabilitative | ||||||
21 | personnel for the provision of rehabilitative
services which is | ||||||
22 | authorized by federal regulations, including
reimbursement for | ||||||
23 | services provided by qualified therapists or qualified
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24 | assistants, and which is in accordance with accepted | ||||||
25 | professional
practices. Reimbursement also may be made for | ||||||
26 | utilization of other
supportive personnel under appropriate |
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1 | supervision.
| ||||||
2 | (Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707, | ||||||
3 | eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09; | ||||||
4 | 96-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff. | ||||||
5 | 7-2-10.)
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6 | Section 99. Effective date. This Act takes effect July 1, | ||||||
7 | 2011.
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