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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 5-5.2 as follows:
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6 | (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
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7 | Sec. 5-5.2. Payment.
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8 | (a) All nursing facilities that are grouped pursuant to | ||||||
9 | Section
5-5.1 of this Act shall receive the same rate of | ||||||
10 | payment for similar
services.
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11 | (b) It shall be a matter of State policy that the Illinois | ||||||
12 | Department
shall utilize a uniform billing cycle throughout the | ||||||
13 | State for the
long-term care providers.
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14 | (c) Notwithstanding any other provisions of this Code, the | ||||||
15 | methodologies for reimbursement of nursing services as | ||||||
16 | provided under this Article shall no longer be applicable for | ||||||
17 | bills payable for nursing services rendered on or after a new | ||||||
18 | reimbursement system based on the Resource Utilization Groups | ||||||
19 | (RUGs) has been fully operationalized, which shall take effect | ||||||
20 | for services provided on or after January 1, 2014. | ||||||
21 | (d) The new nursing services reimbursement methodology | ||||||
22 | utilizing RUG-IV 48 grouper model, which shall be referred to | ||||||
23 | as the RUGs reimbursement system, taking effect January 1, |
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1 | 2014, shall be based on the following: | ||||||
2 | (1) The methodology shall be resident-driven, | ||||||
3 | facility-specific, and cost-based. | ||||||
4 | (2) Costs shall be annually rebased and case mix index | ||||||
5 | quarterly updated. The nursing services methodology will | ||||||
6 | be assigned to the Medicaid enrolled residents on record as | ||||||
7 | of 30 days prior to the beginning of the rate period in the | ||||||
8 | Department's Medicaid Management Information System (MMIS) | ||||||
9 | as present on the last day of the second quarter preceding | ||||||
10 | the rate period based upon the Assessment Reference Date of | ||||||
11 | the Minimum Data Set (MDS) . | ||||||
12 | (3) Regional wage adjustors based on the Health Service | ||||||
13 | Areas (HSA) groupings and adjusters in effect on April 30, | ||||||
14 | 2012 shall be included. | ||||||
15 | (4) Case mix index shall be assigned to each resident | ||||||
16 | class based on the Centers for Medicare and Medicaid | ||||||
17 | Services staff time measurement study in effect on July 1, | ||||||
18 | 2013, utilizing an index maximization approach. | ||||||
19 | (5) The pool of funds available for distribution by | ||||||
20 | case mix and the base facility rate shall be determined | ||||||
21 | using the formula contained in subsection (d-1). | ||||||
22 | (d-1) Calculation of base year Statewide RUG-IV nursing | ||||||
23 | base per diem rate. | ||||||
24 | (1) Base rate spending pool shall be: | ||||||
25 | (A) The base year resident days which are | ||||||
26 | calculated by multiplying the number of Medicaid |
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1 | residents in each nursing home as indicated in the MDS | ||||||
2 | data defined in paragraph (4) by 365. | ||||||
3 | (B) Each facility's nursing component per diem in | ||||||
4 | effect on July 1, 2012 shall be multiplied by | ||||||
5 | subsection (A). | ||||||
6 | (C) Thirteen million is added to the product of | ||||||
7 | subparagraph (A) and subparagraph (B) to adjust for the | ||||||
8 | exclusion of nursing homes defined in paragraph (5). | ||||||
9 | (2) For each nursing home with Medicaid residents as | ||||||
10 | indicated by the MDS data defined in paragraph (4), | ||||||
11 | weighted days adjusted for case mix and regional wage | ||||||
12 | adjustment shall be calculated. For each home this | ||||||
13 | calculation is the product of: | ||||||
14 | (A) Base year resident days as calculated in | ||||||
15 | subparagraph (A) of paragraph (1). | ||||||
16 | (B) The nursing home's regional wage adjustor | ||||||
17 | based on the Health Service Areas (HSA) groupings and | ||||||
18 | adjustors in effect on April 30, 2012. | ||||||
19 | (C) Facility weighted case mix which is the number | ||||||
20 | of Medicaid residents as indicated by the MDS data | ||||||
21 | defined in paragraph (4) multiplied by the associated | ||||||
22 | case weight for the RUG-IV 48 grouper model using | ||||||
23 | standard RUG-IV procedures for index maximization. | ||||||
24 | (D) The sum of the products calculated for each | ||||||
25 | nursing home in subparagraphs (A) through (C) above | ||||||
26 | shall be the base year case mix, rate adjusted weighted |
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1 | days. | ||||||
2 | (3) The Statewide RUG-IV nursing base per diem rate on | ||||||
3 | January 1, 2014 shall be the quotient of the paragraph (1) | ||||||
4 | divided by the sum calculated under subparagraph (D) of | ||||||
5 | paragraph (2). | ||||||
6 | (4) Minimum Data Set (MDS) comprehensive assessments | ||||||
7 | for Medicaid residents on the last day of the quarter used | ||||||
8 | to establish the base rate. | ||||||
9 | (5) Nursing facilities designated as of July 1, 2012 by | ||||||
10 | the Department as "Institutions for Mental Disease" shall | ||||||
11 | be excluded from all calculations under this subsection. | ||||||
12 | The data from these facilities shall not be used in the | ||||||
13 | computations described in paragraphs (1) through (4) above | ||||||
14 | to establish the base rate. | ||||||
15 | (e) Notwithstanding any other provision of this Code, the | ||||||
16 | Department shall by rule develop a reimbursement methodology | ||||||
17 | reflective of the intensity of care and services requirements | ||||||
18 | of low need residents in the lowest RUG IV groupers and | ||||||
19 | corresponding regulations. Only that portion of the RUGs | ||||||
20 | Reimbursement System spending pool described in subsection | ||||||
21 | (d-1) attributed to the groupers as of July 1, 2013 for which | ||||||
22 | the methodology in this Section is developed may be diverted | ||||||
23 | for this purpose. The Department shall submit the rules no | ||||||
24 | later than January 1, 2014 for an implementation date no later | ||||||
25 | than January 1, 2015. If the Department does not implement this | ||||||
26 | reimbursement methodology by the required date, the nursing |
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1 | component per diem on January 1, 2015 for residents classified | ||||||
2 | in RUG-IV groups PA1, PA2, BA1, and BA2 shall be the blended | ||||||
3 | rate of the calculated RUG-IV nursing component per diem and | ||||||
4 | the nursing component per diem in effect on July 1, 2012. This | ||||||
5 | blended rate shall be applied only to nursing homes whose | ||||||
6 | resident population is greater than or equal to 70% of the | ||||||
7 | total residents served and whose RUG-IV nursing component per | ||||||
8 | diem rate is less than the nursing component per diem in effect | ||||||
9 | on July 1, 2012. This blended rate shall be in effect until the | ||||||
10 | reimbursement methodology is implemented or until July 1, 2019, | ||||||
11 | whichever is sooner. | ||||||
12 | (e-1) Notwithstanding any other provision of this Article, | ||||||
13 | rates established pursuant to this subsection shall not apply | ||||||
14 | to any and all nursing facilities designated by the Department | ||||||
15 | as "Institutions for Mental Disease" and shall be excluded from | ||||||
16 | the RUGs Reimbursement System applicable to facilities not | ||||||
17 | designated as "Institutions for the Mentally Diseased" by the | ||||||
18 | Department. | ||||||
19 | (e-2) For dates of services beginning January 1, 2014, the | ||||||
20 | RUG-IV nursing component per diem for a nursing home shall be | ||||||
21 | the product of the statewide RUG-IV nursing base per diem rate, | ||||||
22 | the facility average case mix index, and the regional wage | ||||||
23 | adjustor. Transition rates for services provided between | ||||||
24 | January 1, 2014 and December 31, 2014 shall be as follows: | ||||||
25 | (1) The transition RUG-IV per diem nursing rate for | ||||||
26 | nursing homes whose rate calculated in this subsection |
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1 | (e-2) is greater than the nursing component rate in effect | ||||||
2 | July 1, 2012 shall be paid the sum of: | ||||||
3 | (A) The nursing component rate in effect July 1, | ||||||
4 | 2012; plus | ||||||
5 | (B) The difference of the RUG-IV nursing component | ||||||
6 | per diem calculated for the current quarter minus the | ||||||
7 | nursing component rate in effect July 1, 2012 | ||||||
8 | multiplied by 0.88. | ||||||
9 | (2) The transition RUG-IV per diem nursing rate for | ||||||
10 | nursing homes whose rate calculated in this subsection | ||||||
11 | (e-2) is less than the nursing component rate in effect | ||||||
12 | July 1, 2012 shall be paid the sum of: | ||||||
13 | (A) The nursing component rate in effect July 1, | ||||||
14 | 2012; plus | ||||||
15 | (B) The difference of the RUG-IV nursing component | ||||||
16 | per diem calculated for the current quarter minus the | ||||||
17 | nursing component rate in effect July 1, 2012 | ||||||
18 | multiplied by 0.13. | ||||||
19 | (f) Notwithstanding any other provision of this Code, on | ||||||
20 | and after July 1, 2012, reimbursement rates associated with the | ||||||
21 | nursing or support components of the current nursing facility | ||||||
22 | rate methodology shall not increase beyond the level effective | ||||||
23 | May 1, 2011 until a new reimbursement system based on the RUGs | ||||||
24 | IV 48 grouper model has been fully operationalized. | ||||||
25 | (g) Notwithstanding any other provision of this Code, on | ||||||
26 | and after July 1, 2012, for facilities not designated by the |
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1 | Department of Healthcare and Family Services as "Institutions | ||||||
2 | for Mental Disease", rates effective May 1, 2011 shall be | ||||||
3 | adjusted as follows: | ||||||
4 | (1) Individual nursing rates for residents classified | ||||||
5 | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | ||||||
6 | ending March 31, 2012 shall be reduced by 10%; | ||||||
7 | (2) Individual nursing rates for residents classified | ||||||
8 | in all other RUG IV groups shall be reduced by 1.0%; | ||||||
9 | (3) Facility rates for the capital and support | ||||||
10 | components shall be reduced by 1.7%. | ||||||
11 | (h) Notwithstanding any other provision of this Code, on | ||||||
12 | and after July 1, 2012, nursing facilities designated by the | ||||||
13 | Department of Healthcare and Family Services as "Institutions | ||||||
14 | for Mental Disease" and "Institutions for Mental Disease" that | ||||||
15 | are facilities licensed under the Specialized Mental Health | ||||||
16 | Rehabilitation Act of 2013 shall have the nursing, | ||||||
17 | socio-developmental, capital, and support components of their | ||||||
18 | reimbursement rate effective May 1, 2011 reduced in total by | ||||||
19 | 2.7%. | ||||||
20 | (Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section | ||||||
21 | 6-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff. | ||||||
22 | 7-22-13; revised 9-19-13.)
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23 | Section 99. Effective date. This Act takes effect upon | ||||||
24 | becoming law.
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