Sen. Donne E. Trotter

Filed: 3/25/2014

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 741

2    AMENDMENT NO. ______. Amend Senate Bill 741 by replacing
3everything after the enacting clause with the following:
 
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

 

 

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1bills payable for nursing services rendered on or after a new
2reimbursement system based on the Resource Utilization Groups
3(RUGs) has been fully operationalized, which shall take effect
4for services provided on or after January 1, 2014.
5    (d) The new nursing services reimbursement methodology
6utilizing RUG-IV 48 grouper model, which shall be referred to
7as the RUGs reimbursement system, taking effect January 1,
82014, shall be based on the following:
9        (1) The methodology shall be resident-driven,
10    facility-specific, and cost-based.
11        (2) Costs shall be annually rebased and case mix index
12    quarterly updated. The nursing services methodology will
13    be assigned to the Medicaid enrolled residents on record as
14    of 30 days prior to the beginning of the rate period in the
15    Department's Medicaid Management Information System (MMIS)
16    as present on the last day of the second quarter preceding
17    the rate period.
18        (3) Regional wage adjustors based on the Health Service
19    Areas (HSA) groupings and adjusters in effect on April 30,
20    2012 shall be included.
21        (4) Case mix index shall be assigned to each resident
22    class based on the Centers for Medicare and Medicaid
23    Services staff time measurement study in effect on July 1,
24    2013, utilizing an index maximization approach.
25        (5) The pool of funds available for distribution by
26    case mix and the base facility rate shall be determined

 

 

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1    using the formula contained in subsection (d-1).
2    (d-1) Calculation of base year Statewide RUG-IV nursing
3base per diem rate.
4        (1) Base rate spending pool shall be:
5            (A) The base year resident days which are
6        calculated by multiplying the number of Medicaid
7        residents in each nursing home as indicated in the MDS
8        data defined in paragraph (4) by 365.
9            (B) Each facility's nursing component per diem in
10        effect on July 1, 2012 shall be multiplied by
11        subsection (A).
12            (C) Thirteen million is added to the product of
13        subparagraph (A) and subparagraph (B) to adjust for the
14        exclusion of nursing homes defined in paragraph (5).
15        (2) For each nursing home with Medicaid residents as
16    indicated by the MDS data defined in paragraph (4),
17    weighted days adjusted for case mix and regional wage
18    adjustment shall be calculated. For each home this
19    calculation is the product of:
20            (A) Base year resident days as calculated in
21        subparagraph (A) of paragraph (1).
22            (B) The nursing home's regional wage adjustor
23        based on the Health Service Areas (HSA) groupings and
24        adjustors in effect on April 30, 2012.
25            (C) Facility weighted case mix which is the number
26        of Medicaid residents as indicated by the MDS data

 

 

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1        defined in paragraph (4) multiplied by the associated
2        case weight for the RUG-IV 48 grouper model using
3        standard RUG-IV procedures for index maximization.
4            (D) The sum of the products calculated for each
5        nursing home in subparagraphs (A) through (C) above
6        shall be the base year case mix, rate adjusted weighted
7        days.
8        (3) The Statewide RUG-IV nursing base per diem rate on
9    January 1, 2014 shall be the quotient of the paragraph (1)
10    divided by the sum calculated under subparagraph (D) of
11    paragraph (2).
12        (4) Minimum Data Set (MDS) comprehensive assessments
13    for Medicaid residents on the last day of the quarter used
14    to establish the base rate.
15        (5) Nursing facilities designated as of July 1, 2012 by
16    the Department as "Institutions for Mental Disease" shall
17    be excluded from all calculations under this subsection.
18    The data from these facilities shall not be used in the
19    computations described in paragraphs (1) through (4) above
20    to establish the base rate.
21    (e) Notwithstanding any other provision of this Code, the
22Department shall by rule develop a reimbursement methodology
23reflective of the intensity of care and services requirements
24of low need residents in the lowest RUG IV groupers and
25corresponding regulations. Only that portion of the RUGs
26Reimbursement System spending pool described in subsection

 

 

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1(d-1) attributed to the groupers as of July 1, 2013 for which
2the methodology in this Section is developed may be diverted
3for this purpose. The Department shall submit the rules no
4later than January 1, 2014 for an implementation date no later
5than January 1, 2015. If the Department does not implement this
6reimbursement methodology by the required date, the nursing
7component per diem on January 1, 2015 for residents classified
8in RUG-IV groups PA1, PA2, BA1, and BA2 shall be the blended
9rate of the calculated RUG-IV nursing component per diem and
10the nursing component per diem in effect on July 1, 2012. This
11blended rate shall be applied only to nursing homes whose
12resident population is greater than or equal to 70% of the
13total residents served and whose RUG-IV nursing component per
14diem rate is less than the nursing component per diem in effect
15on July 1, 2012. This blended rate shall be in effect until the
16reimbursement methodology is implemented or until July 1, 2019,
17whichever is sooner.
18    (e-1) Notwithstanding any other provision of this Article,
19rates established pursuant to this subsection shall not apply
20to any and all nursing facilities designated by the Department
21as "Institutions for Mental Disease" and shall be excluded from
22the RUGs Reimbursement System applicable to facilities not
23designated as "Institutions for the Mentally Diseased" by the
24Department.
25    (e-2) For dates of services beginning January 1, 2014, the
26RUG-IV nursing component per diem for a nursing home shall be

 

 

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1the product of the statewide RUG-IV nursing base per diem rate,
2the facility average case mix index, and the regional wage
3adjustor. Transition rates for services provided between
4January 1, 2014 and December 31, 2014 shall be as follows:
5        (1) The transition RUG-IV per diem nursing rate for
6    nursing homes whose rate calculated in this subsection
7    (e-2) is greater than the nursing component rate in effect
8    July 1, 2012 shall be paid the sum of:
9            (A) The nursing component rate in effect July 1,
10        2012; plus
11            (B) The difference of the RUG-IV nursing component
12        per diem calculated for the current quarter minus the
13        nursing component rate in effect July 1, 2012
14        multiplied by 0.88.
15        (2) The transition RUG-IV per diem nursing rate for
16    nursing homes whose rate calculated in this subsection
17    (e-2) is less than the nursing component rate in effect
18    July 1, 2012 shall be paid the sum of:
19            (A) The nursing component rate in effect July 1,
20        2012; plus
21            (B) The difference of the RUG-IV nursing component
22        per diem calculated for the current quarter minus the
23        nursing component rate in effect July 1, 2012
24        multiplied by 0.13.
25    (e-3) Notwithstanding any other provisions of this Code, on
26and after January 1, 2014, the per diem reimbursement rate for

 

 

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1each individual resident receiving ventilator services,
2including those receiving weaning services, shall include the
3nursing, support, and capital components in effect at the time
4the service is provided plus a service fee of $34 per resident
5per day and a supply fee of $174 per resident per day.
6    (f) Notwithstanding any other provision of this Code, on
7and after July 1, 2012, reimbursement rates associated with the
8nursing or support components of the current nursing facility
9rate methodology shall not increase beyond the level effective
10May 1, 2011 until a new reimbursement system based on the RUGs
11IV 48 grouper model has been fully operationalized.
12    (g) Notwithstanding any other provision of this Code, on
13and after July 1, 2012, for facilities not designated by the
14Department of Healthcare and Family Services as "Institutions
15for Mental Disease", rates effective May 1, 2011 shall be
16adjusted as follows:
17        (1) Individual nursing rates for residents classified
18    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter
19    ending March 31, 2012 shall be reduced by 10%;
20        (2) Individual nursing rates for residents classified
21    in all other RUG IV groups shall be reduced by 1.0%;
22        (3) Facility rates for the capital and support
23    components shall be reduced by 1.7%.
24    (h) Notwithstanding any other provision of this Code, on
25and after July 1, 2012, nursing facilities designated by the
26Department of Healthcare and Family Services as "Institutions

 

 

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1for Mental Disease" and "Institutions for Mental Disease" that
2are facilities licensed under the Specialized Mental Health
3Rehabilitation Act of 2013 shall have the nursing,
4socio-developmental, capital, and support components of their
5reimbursement rate effective May 1, 2011 reduced in total by
62.7%.
7(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section
86-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff.
97-22-13; revised 9-19-13.)
 
10    Section 99. Effective date. This Act takes effect upon
11becoming law.".