HB4600 EnrolledLRB098 17867 KTG 52991 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 Section 5-5.2 as follows:
 
6    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
7    Sec. 5-5.2. Payment.
8    (a) All nursing facilities that are grouped pursuant to
9Section 5-5.1 of this Act shall receive the same rate of
10payment for similar services.
11    (b) It shall be a matter of State policy that the Illinois
12Department shall utilize a uniform billing cycle throughout the
13State for the long-term care providers.
14    (c) Notwithstanding any other provisions of this Code, the
15methodologies for reimbursement of nursing services as
16provided under this Article shall no longer be applicable for
17bills payable for nursing services rendered on or after a new
18reimbursement system based on the Resource Utilization Groups
19(RUGs) has been fully operationalized, which shall take effect
20for services provided on or after January 1, 2014.
21    (d) The new nursing services reimbursement methodology
22utilizing RUG-IV 48 grouper model, which shall be referred to
23as the RUGs reimbursement system, taking effect January 1,

 

 

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12014, 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
23base 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
16Department shall by rule develop a reimbursement methodology
17reflective of the intensity of care and services requirements
18of low need residents in the lowest RUG IV groupers and
19corresponding regulations. Only that portion of the RUGs
20Reimbursement System spending pool described in subsection
21(d-1) attributed to the groupers as of July 1, 2013 for which
22the methodology in this Section is developed may be diverted
23for this purpose. The Department shall submit the rules no
24later than January 1, 2014 for an implementation date no later
25than January 1, 2015. If the Department does not implement this
26reimbursement methodology by the required date, the nursing

 

 

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1component per diem on January 1, 2015 for residents classified
2in RUG-IV groups PA1, PA2, BA1, and BA2 shall be the blended
3rate of the calculated RUG-IV nursing component per diem and
4the nursing component per diem in effect on July 1, 2012. This
5blended rate shall be applied only to nursing homes whose
6resident population is greater than or equal to 70% of the
7total residents served and whose RUG-IV nursing component per
8diem rate is less than the nursing component per diem in effect
9on July 1, 2012. This blended rate shall be in effect until the
10reimbursement methodology is implemented or until July 1, 2019,
11whichever is sooner.
12    (e-1) Notwithstanding any other provision of this Article,
13rates established pursuant to this subsection shall not apply
14to any and all nursing facilities designated by the Department
15as "Institutions for Mental Disease" and shall be excluded from
16the RUGs Reimbursement System applicable to facilities not
17designated as "Institutions for the Mentally Diseased" by the
18Department.
19    (e-2) For dates of services beginning January 1, 2014, the
20RUG-IV nursing component per diem for a nursing home shall be
21the product of the statewide RUG-IV nursing base per diem rate,
22the facility average case mix index, and the regional wage
23adjustor. Transition rates for services provided between
24January 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
20and after July 1, 2012, reimbursement rates associated with the
21nursing or support components of the current nursing facility
22rate methodology shall not increase beyond the level effective
23May 1, 2011 until a new reimbursement system based on the RUGs
24IV 48 grouper model has been fully operationalized.
25    (g) Notwithstanding any other provision of this Code, on
26and after July 1, 2012, for facilities not designated by the

 

 

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1Department of Healthcare and Family Services as "Institutions
2for Mental Disease", rates effective May 1, 2011 shall be
3adjusted 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
12and after July 1, 2012, nursing facilities designated by the
13Department of Healthcare and Family Services as "Institutions
14for Mental Disease" and "Institutions for Mental Disease" that
15are facilities licensed under the Specialized Mental Health
16Rehabilitation Act of 2013 shall have the nursing,
17socio-developmental, capital, and support components of their
18reimbursement rate effective May 1, 2011 reduced in total by
192.7%.
20(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section
216-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff.
227-22-13; revised 9-19-13.)
 
23    Section 99. Effective date. This Act takes effect upon
24becoming law.