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Full Text of SB2995  102nd General Assembly

SB2995 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB2995

 

Introduced 1/5/2022, by Sen. Ann Gillespie

 

SYNOPSIS AS INTRODUCED:
 
See Index

    Amends the Nurse Agency Licensing Act. Prohibits nurse agencies from entering into covenants not to compete with nurses and certified nurse aides who are employed by the agencies. Provides that a supplemental healthcare staffing agency must not bill nor receive payments from a licensed health care facility at a rate higher than 130% of the sum of total compensation plus associated payroll taxes for applicable employee classifications. Provides that the maximum charge must include all charges for administrative fees, contract fees, or other special charges in addition to compensation for the temporary nursing pool personnel supplied to a health care facility. Amends the Illinois Public Aid Code. Provides that is shall be a matter of State policy that the Department of Healthcare and Family Services shall set nursing facility rates, by rule, utilizing an evidence-based methodology that rewards appropriate staffing, quality-of-life improvements for nursing facility residents, and the reduction of racial inequities and health disparities for nursing facility residents enrolled in Medicaid. Contains provisions concerning the Patient Driven Payment Model for nursing services reimbursements; utilization of the Staff Time and Resource Intensity Verification study; the statewide base rate for certain dates of service; the establishment of a variable per diem add-on for nursing facilities with specified staffing levels; directed payments to improve the quality of care delivered by nursing facilities; occupied bed tax amounts beginning January 1, 2022, emergency rules; and other matters. Schedules for repeal on July 1, 2024 the Nursing Home License Fee Article of the Code. Amends the Illinois Administrative Procedure Act. Permits the Department of Healthcare and Family Services to adopt emergency rules to implement certain changes made by the amendatory Act.


LRB102 22475 KTG 31615 b

 

 

A BILL FOR

 

SB2995LRB102 22475 KTG 31615 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 Administrative Procedure Act is
5amended by adding Section 5-45.20 as follows:
 
6    (5 ILCS 100/5-45.20 new)
7    Sec. 5-45.20. Emergency rulemaking; nursing facility
8payment rates. To provide for the expeditious and timely
9implementation of changes made to Section 5-5.2 of the
10Illinois Public Aid Code by this amendatory Act of the 102nd
11General Assembly, emergency rules implementing such changes
12may be adopted in accordance with Section 5-45 by the
13Department of Healthcare and Family Services. The adoption of
14emergency rules authorized by Section 5-45 and this Section is
15deemed to be necessary for the public interest, safety, and
16welfare. This Section is repealed on January 1, 2023.
 
17    Section 10. The Nurse Agency Licensing Act is amended by
18changing Sections 3 and 14 as follows:
 
19    (225 ILCS 510/3)  (from Ch. 111, par. 953)
20    Sec. 3. Definitions. As used in this Act:
21    (a) "Certified nurse aide" means an individual certified

 

 

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1as defined in Section 3-206 of the Nursing Home Care Act,
2Section 3-206 of the ID/DD Community Care Act, or Section
33-206 of the MC/DD Act, as now or hereafter amended.
4    (b) "Department" means the Department of Labor.
5    (c) "Director" means the Director of Labor.
6    (d) "Health care facility" is defined as in Section 3 of
7the Illinois Health Facilities Planning Act, as now or
8hereafter amended.
9    (e) "Licensee" means any nursing agency which is properly
10licensed under this Act.
11    (f) "Nurse" means a registered nurse or a licensed
12practical nurse as defined in the Nurse Practice Act.
13    (g) "Nurse agency" means any individual, firm,
14corporation, partnership or other legal entity that employs,
15assigns or refers nurses or certified nurse aides to a health
16care facility for a fee. The term "nurse agency" includes
17nurses registries. The term "nurse agency" does not include
18services provided by home health agencies licensed and
19operated under the Home Health, Home Services, and Home
20Nursing Agency Licensing Act or a licensed or certified
21individual who provides his or her own services as a regular
22employee of a health care facility, nor does it apply to a
23health care facility's organizing nonsalaried employees to
24provide services only in that facility.
25    (h) "Covenant not to compete" means an agreement between
26an employer and an employee that restricts such employee from

 

 

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1performing:
2        (1) any work for another employer for a specified
3    period of time;
4        (2) any work in a specified geographical area; or
5        (3) work for another employer that is similar to such
6    employee's work for the employer included as a party to
7    the agreement.
8(Source: P.A. 98-104, eff. 7-22-13; 99-180, eff. 7-29-15.)
 
9    (225 ILCS 510/14)  (from Ch. 111, par. 964)
10    Sec. 14. Minimum Standards. (a) The Department, by rule,
11shall establish minimum standards for the operation of nurse
12agencies. Those standards shall include, but are not limited
13to: (1) the maintenance of written policies and procedures;
14and (2) the development of personnel policies which include a
15personal interview, a reference check, an annual evaluation of
16each employee (which may be based in part upon information
17provided by health care facilities utilizing nurse agency
18personnel) and periodic health examinations.
19    (b) Each nurse agency shall have a nurse serving as a
20manager or supervisor of all nurses and certified nurses
21aides.
22    (c) Each nurse agency shall ensure that its employees meet
23the minimum licensing, training, and orientation standards for
24which those employees are licensed or certified.
25    (d) A nurse agency shall not employ, assign, or refer for

 

 

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1use in an Illinois health care facility a nurse or certified
2nurse aide unless certified or licensed under applicable
3provisions of State and federal law or regulations. Each
4certified nurse aide shall comply with all pertinent
5regulations of the Illinois Department of Public Health
6relating to the health and other qualifications of personnel
7employed in health care facilities.
8    (e) The Department may adopt rules to monitor the usage of
9nurse agency services to determine their impact.
10    (f) Nurse agencies are prohibited from requiring, as a
11condition of employment, assignment, or referral, that their
12employees recruit new employees for the nurse agency from
13among the permanent employees of the health care facility to
14which the nurse agency employees have been employed, assigned,
15or referred, and the health care facility to which such
16employees are employed, assigned, or referred is prohibited
17from requiring, as a condition of employment, that their
18employees recruit new employees from these nurse agency
19employees. Violation of this provision is a business offense.
20    (g) Nurse agencies are prohibited from entering into
21covenants not to compete with nurses and certified nurse aides
22who are employed by the agencies. After the effective date of
23this amendatory Act of the 102nd General Assembly, a covenant
24not to compete entered into between a nurse agency and a
25certified nurse aide is illegal and void.
26    (h) Maximum charges. A supplemental healthcare staffing

 

 

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1agency must not bill nor receive payments from a health care
2facility licensed by the State at a rate higher than 130% of
3the sum of total compensation plus associated payroll taxes
4for applicable employee classifications. Agencies must submit
5a confidential report to the Department of Employment Security
6on a quarterly basis the sum of total compensation plus
7associated payroll taxes for all applicable employee
8classifications, and shall separately include in this report
9the total revenue received from health care facilities
10licensed by the State for the same period for these employees,
11thereby enabling the Department's calculation of the ratio of
12these 2 totals. This ratio shall be used by the Department to
13determine compliance with this maximum charge provision, and
14the veracity of the underlying data shall be subject to audit
15by the Department as well as by the Auditor General. For
16purposes of this subsection, total compensation shall include,
17at a minimum, wages defined as hourly rate of pay and shift
18differential, including weekend shift differential and
19overtime.
20    The maximum charge must include all charges for
21administrative fees, contract fees, or other special charges
22in addition to compensation for the temporary nursing pool
23personnel supplied to a health care facility. A health care
24facility that pays for the actual travel and housing costs for
25supplemental healthcare staffing agency staff working at the
26facility and that pays these costs to the employee, the

 

 

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1agency, or another vendor, is not required to count these
2costs as total compensation.
3(Source: P.A. 86-817.)
 
4    Section 15. The Illinois Public Aid Code is amended by
5changing Sections 5-5.2, 5B-2, 5B-4, 5B-5, 5B-8, 5E-10, and by
6adding Section 5E-20 as follows:
 
7    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
8    Sec. 5-5.2. Payment.
9    (a) All nursing facilities that are grouped pursuant to
10Section 5-5.1 of this Act shall receive the same rate of
11payment for similar services.
12    (b) It shall be a matter of State policy that the Illinois
13Department shall utilize a uniform billing cycle throughout
14the State for the long-term care providers.
15    (b-1) It shall be a matter of State policy that the
16Department shall set nursing facility rates, by rule,
17utilizing an evidence-based methodology that rewards
18appropriate staffing, quality-of-life improvements for nursing
19facility residents, and the reduction of racial inequities and
20health disparities for nursing facility residents enrolled in
21Medicaid.
22    (c) (Blank). Notwithstanding any other provisions of this
23Code, the methodologies for reimbursement of nursing services
24as provided under this Article shall no longer be applicable

 

 

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1for bills payable for nursing services rendered on or after a
2new reimbursement system based on the Resource Utilization
3Groups (RUGs) has been fully operationalized, which shall take
4effect for services provided on or after January 1, 2014.
5    (d) The new nursing services reimbursement methodology
6utilizing the Patient Driven Payment Model RUG-IV 48 grouper
7model, which shall be referred to as the PDPM RUGs
8reimbursement system, taking effect January 1, 2022, upon
9federal approval by the Centers for Medicare and Medicaid
10Services 2014, shall be based on the following:
11        (1) The methodology shall be resident-centered
12    resident-driven, facility-specific, and based on guidance
13    from the Centers for Medicare and Medicaid Services
14    cost-based.
15        (2) Costs shall be annually rebased and case mix index
16    quarterly updated. The nursing services methodology will
17    be assigned to the Medicaid enrolled residents on record
18    as of 30 days prior to the beginning of the rate period in
19    the Department's Medicaid Management Information System
20    (MMIS) as present on the last day of the second quarter
21    preceding the rate period based upon the Assessment
22    Reference Date of the Minimum Data Set (MDS).
23        (3) Regional wage adjustors based on the Health
24    Service Areas (HSA) groupings and adjusters in effect on
25    January 1, 2022 April 30, 2012 shall be included, except
26    no adjuster shall be lower than 1.0.

 

 

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1        (4) PDPM nursing case-mix indices in effect on May 1,
2    2021 Case mix index shall be assigned to each resident
3    class based on the Centers for Medicare and Medicaid
4    Services staff time measurement study called Staff Time
5    and Resource Intensity Verification (STRIVE) in effect on
6    July 1, 2013, adjusted by a uniform multiplier to achieve
7    the same statewide case mix index value observed for the
8    quarter beginning April 1, 2021 while holding PA1, PA2,
9    BA1, and BB1 resident classes at the level applicable
10    under the RUG-IV payment model prior to January 1, 2022
11    utilizing an index maximization approach.
12        (5) (Blank). The pool of funds available for
13    distribution by case mix and the base facility rate shall
14    be determined using the formula contained in subsection
15    (d-1).
16        (6) The statewide base rate for dates of service
17    before January 1, 2022 shall be $85.25, and thereafter
18    shall be no less than $90.25.
19        (7) The Department shall establish a variable per diem
20    add-on based on information from the most recent available
21    federal staffing report, currently the Payroll Based
22    Journal, adjusted for acuity if applicable using the same
23    quarter's MDS. The variable per diem add-on shall be paid
24    only to facilities with at least 70% of the staffing
25    indicated by the STRIVE study. For facilities at 70% of
26    the staffing indicated by the STRIVE study, those

 

 

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1    facilities shall be paid a per diem add-on of $9,
2    increasing by equivalent steps for each whole percentage
3    point of improvement until the facilities reach a per diem
4    of $14.88. For facilities with at least 80% of the
5    staffing indicated by the STRIVE study, those facilities
6    shall be paid a per diem add-on of $14.88, increasing by
7    equivalent steps for each whole percentage point of
8    improvement until the facilities reach a per diem add-on
9    of $23.80. For facilities with at least 92% of the
10    staffing indicated by the STRIVE study, those facilities
11    shall be paid a per diem add-on of $23.80, increasing by
12    equivalent steps for each whole percentage point of
13    improvement until the facilities reach a per diem add-on
14    of $29.75. For facilities with at least 100% of the
15    staffing indicated by the STRIVE study, those facilities
16    shall be paid a per diem add-on of $29.75, increasing by
17    equivalent steps for each whole percentage point of
18    improvement until the facilities reach a per diem add-on
19    of $35.70. For facilities with at least 110% of the
20    staffing indicated by the STRIVE study, those facilities
21    shall be paid a per diem add-on of $35.70, increasing by
22    equivalent steps for each whole percentage point of
23    improvement until the facilities reach a per diem add-on
24    of $38.68. For facilities with 125% of the staffing
25    indicated by the STRIVE study or more, those facilities
26    shall be paid a per diem add-on of $38.68. The Department

 

 

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1    shall establish, by rule, a limit of not more than a 5
2    percentage point drop per once-consecutive quarter in the
3    STRIVE percentage used to determine the variable per diem
4    add-on.
5    (d-1) (Blank). Calculation of base year Statewide RUG-IV
6nursing base per diem rate.
7        (1) Base rate spending pool shall be:
8            (A) The base year resident days which are
9        calculated by multiplying the number of Medicaid
10        residents in each nursing home as indicated in the MDS
11        data defined in paragraph (4) by 365.
12            (B) Each facility's nursing component per diem in
13        effect on July 1, 2012 shall be multiplied by
14        subsection (A).
15            (C) Thirteen million is added to the product of
16        subparagraph (A) and subparagraph (B) to adjust for
17        the exclusion of nursing homes defined in paragraph
18        (5).
19        (2) For each nursing home with Medicaid residents as
20    indicated by the MDS data defined in paragraph (4),
21    weighted days adjusted for case mix and regional wage
22    adjustment shall be calculated. For each home this
23    calculation is the product of:
24            (A) Base year resident days as calculated in
25        subparagraph (A) of paragraph (1).
26            (B) The nursing home's regional wage adjustor

 

 

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1        based on the Health Service Areas (HSA) groupings and
2        adjustors in effect on April 30, 2012.
3            (C) Facility weighted case mix which is the number
4        of Medicaid residents as indicated by the MDS data
5        defined in paragraph (4) multiplied by the associated
6        case weight for the RUG-IV 48 grouper model using
7        standard RUG-IV procedures for index maximization.
8            (D) The sum of the products calculated for each
9        nursing home in subparagraphs (A) through (C) above
10        shall be the base year case mix, rate adjusted
11        weighted days.
12        (3) The Statewide RUG-IV nursing base per diem rate:
13            (A) on January 1, 2014 shall be the quotient of the
14        paragraph (1) divided by the sum calculated under
15        subparagraph (D) of paragraph (2); and
16            (B) on and after July 1, 2014, shall be the amount
17        calculated under subparagraph (A) of this paragraph
18        (3) plus $1.76.
19        (4) Minimum Data Set (MDS) comprehensive assessments
20    for Medicaid residents on the last day of the quarter used
21    to establish the base rate.
22        (5) Nursing facilities designated as of July 1, 2012
23    by the Department as "Institutions for Mental Disease"
24    shall be excluded from all calculations under this
25    subsection. The data from these facilities shall not be
26    used in the computations described in paragraphs (1)

 

 

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1    through (4) above to establish the base rate.
2    (e) Beginning July 1, 2014 through December 31, 2021, the
3Department shall allocate funding in the amount up to
4$10,000,000 for per diem add-ons to the RUGS methodology for
5dates of service on and after July 1, 2014:
6        (1) $0.63 for each resident who scores in I4200
7    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
8        (2) $2.67 for each resident who scores either a "1" or
9    "2" in any items S1200A through S1200I and also scores in
10    RUG groups PA1, PA2, BA1, or BA2.
11        (3) Beginning on and after January 1, 2022, the
12    Department shall allocate funding, by rule, for per diem
13    add-ons to the PDPM methodology for each resident with a
14    diagnosis of Alzheimer's disease.
15    (e-1) (Blank).
16    (e-2) (Blank). For dates of services beginning January 1,
172014, the RUG-IV nursing component per diem for a nursing home
18shall be the product of the statewide RUG-IV nursing base per
19diem rate, the facility average case mix index, and the
20regional wage adjustor. Transition rates for services provided
21between January 1, 2014 and December 31, 2014 shall be as
22follows:
23        (1) The transition RUG-IV per diem nursing rate for
24    nursing homes whose rate calculated in this subsection
25    (e-2) is greater than the nursing component rate in effect
26    July 1, 2012 shall be paid the sum of:

 

 

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1            (A) The nursing component rate in effect July 1,
2        2012; plus
3            (B) The difference of the RUG-IV nursing component
4        per diem calculated for the current quarter minus the
5        nursing component rate in effect July 1, 2012
6        multiplied by 0.88.
7        (2) The transition RUG-IV per diem nursing rate for
8    nursing homes whose rate calculated in this subsection
9    (e-2) is less than the nursing component rate in effect
10    July 1, 2012 shall be paid the sum of:
11            (A) The nursing component rate in effect July 1,
12        2012; plus
13            (B) The difference of the RUG-IV nursing component
14        per diem calculated for the current quarter minus the
15        nursing component rate in effect July 1, 2012
16        multiplied by 0.13.
17    (f) Notwithstanding any other provision of this Code, on
18and after July 1, 2012, reimbursement rates associated with
19the nursing or support components of the current nursing
20facility rate methodology shall not increase beyond the level
21effective May 1, 2011 until a new reimbursement system based
22on the RUGs IV 48 grouper model has been fully
23operationalized.
24    (g) Notwithstanding any other provision of this Code, on
25and after July 1, 2012, for facilities not designated by the
26Department of Healthcare and Family Services as "Institutions

 

 

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1for Mental Disease", rates effective May 1, 2011 shall be
2adjusted as follows:
3        (1) (Blank); Individual nursing rates for residents
4    classified in RUG IV groups PA1, PA2, BA1, and BA2 during
5    the quarter ending March 31, 2012 shall be reduced by 10%;
6        (2) (Blank); Individual nursing rates for residents
7    classified in all other RUG IV groups shall be reduced by
8    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    (i) On and after July 1, 2014, the reimbursement rates for
21the support component of the nursing facility rate for
22facilities licensed under the Nursing Home Care Act as skilled
23or intermediate care facilities shall be the rate in effect on
24June 30, 2014 increased by 8.17%.
25    (j) Notwithstanding any other provision of law, subject to
26federal approval, effective July 1, 2019, sufficient funds

 

 

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1shall be allocated for changes to rates for facilities
2licensed under the Nursing Home Care Act as skilled nursing
3facilities or intermediate care facilities for dates of
4services on and after July 1, 2019: (i) to establish, through
5December 31, 2021 or upon implementation of the variable per
6diem add-on for staffing under paragraph (7) of subsection
7(d), whichever is later, a per diem add-on to the direct care
8per diem rate not to exceed $70,000,000 annually in the
9aggregate taking into account federal matching funds for the
10purpose of addressing the facility's unique staffing needs,
11adjusted quarterly and distributed by a weighted formula based
12on Medicaid bed days on the last day of the second quarter
13preceding the quarter for which the rate is being adjusted.
14Beginning January 1, 2022, or upon implementation of the
15variable per diem add-on for staffing under paragraph (7) of
16subsection (d), whichever is later, the annual $70,000,000
17described in the preceding sentence shall be dedicated to the
18variable per diem add-on for staffing under paragraph (7) of
19subsection (d); and (ii) in an amount not to exceed
20$170,000,000 annually in the aggregate taking into account
21federal matching funds to permit the support component of the
22nursing facility rate to be updated as follows:
23        (1) 80%, or $136,000,000, of the funds shall be used
24    to update each facility's rate in effect on June 30, 2019
25    using the most recent cost reports on file, which have had
26    a limited review conducted by the Department of Healthcare

 

 

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1    and Family Services and will not hold up enacting the rate
2    increase, with the Department of Healthcare and Family
3    Services and taking into account subsection (i).
4        (2) After completing the calculation in paragraph (1),
5    any facility whose rate is less than the rate in effect on
6    June 30, 2019 shall have its rate restored to the rate in
7    effect on June 30, 2019 from the 20% of the funds set
8    aside.
9        (3) The remainder of the 20%, or $34,000,000, shall be
10    used to increase each facility's rate by an equal
11    percentage.
12    In order to provide for the expeditious and timely
13implementation of the provisions of this amendatory Act of the
14102nd General Assembly, emergency rules to implement any
15provision of this amendatory Act of the 102nd General Assembly
16may be adopted in accordance with this subsection by the
17agency charged with administering that provision or
18initiative. The 24-month limitation on the adoption of
19emergency rules does not apply to rules adopted under this
20subsection. The adoption of emergency rules authorized by this
21subsection is deemed to be necessary for the public interest,
22safety, and welfare.
23    To implement item (i) in this subsection, facilities shall
24file quarterly reports documenting compliance with its
25annually approved staffing plan, which shall permit compliance
26with Section 3-202.05 of the Nursing Home Care Act. A facility

 

 

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1that fails to meet the benchmarks and dates contained in the
2plan may have its add-on adjusted in the quarter following the
3quarterly review. Nothing in this Section shall limit the
4ability of the facility to appeal a ruling of non-compliance
5and a subsequent reduction to the add-on. Funds adjusted for
6noncompliance shall be maintained in the Long-Term Care
7Provider Fund and accounted for separately. At the end of each
8fiscal year, these funds shall be made available to facilities
9for special staffing projects.
10    In order to provide for the expeditious and timely
11implementation of the provisions of Public Act 101-10,
12emergency rules to implement any provision of Public Act
13101-10 may be adopted in accordance with this subsection by
14the agency charged with administering that provision or
15initiative. The agency shall simultaneously file emergency
16rules and permanent rules to ensure that there is no
17interruption in administrative guidance. The 150-day
18limitation of the effective period of emergency rules does not
19apply to rules adopted under this subsection, and the
20effective period may continue through June 30, 2021. The
2124-month limitation on the adoption of emergency rules does
22not apply to rules adopted under this subsection. The adoption
23of emergency rules authorized by this subsection is deemed to
24be necessary for the public interest, safety, and welfare.
25    (k) During the first quarter of State Fiscal Year 2020,
26the Department of Healthcare of Family Services must convene a

 

 

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1technical advisory group consisting of members of all trade
2associations representing Illinois skilled nursing providers
3to discuss changes necessary with federal implementation of
4Medicare's Patient-Driven Payment Model. Implementation of
5Medicare's Patient-Driven Payment Model shall, by September 1,
62020, end the collection of the MDS data that is necessary to
7maintain the current RUG-IV Medicaid payment methodology. The
8technical advisory group must consider a revised reimbursement
9methodology that takes into account transparency,
10accountability, actual staffing as reported under the
11federally required Payroll Based Journal system, changes to
12the minimum wage, adequacy in coverage of the cost of care, and
13a quality component that rewards quality improvements.
14    (l) The Department shall establish directed payments to
15improve the quality of care delivered by facilities,
16including:
17        (1) Incentive payments determined by facility
18    performance on specified quality measures in an initial
19    amount of $70,000,000. Nothing in this Section shall be
20    construed to limit the quality of care directed payments
21    to $70,000,000, and in the case that quality of care has
22    improved across nursing facilities, the Department shall
23    adjust those directed payments accordingly. The quality
24    payment methodology described in this Section must be used
25    for at least the first 2 quarters in calendar year 2022.
26    Beginning with the quarter starting July 1, 2022, the

 

 

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1    Department may add, remove, or change quality metrics and
2    make associated changes to the quality payment methodology
3    as outlined in subparagraph (E). Facilities designated by
4    the Centers for Medicare and Medicaid Services as a
5    special focus facility or a hospital-based nursing home do
6    not qualify for quality payments.
7            (A) Each quality pool must be distributed by
8        assigning a quality weighted score for each nursing
9        home which is calculated by multiplying the nursing
10        home's quality base period Medicaid days by the
11        nursing home's star rating weight in that period.
12            (B) Star rating weights are assigned based on the
13        nursing home's star rating for the LTS quality star
14        rating. "LTS quality star rating" means the long stay
15        quality rating for each nursing facility as assigned
16        by the Centers for Medicare and Medicaid Services
17        under the Five-Star Quality Rating System. The rating
18        is a number ranging from 0 (lowest) to 5 (highest).
19                (i) Zero or one star rating has a weight of 0.
20                (ii) Two star rating has a weight of 0.75.
21                (iii) Three star rating has a weight of 1.5.
22                (iv) Four star rating has a weight of 2.5.
23                (v) Five star rating has a weight of 3.5.
24            (C) Each nursing home's quality weight score is
25        divided by the sum of all quality weight scores for
26        qualifying nursing homes to determine the proportion

 

 

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1        of the quality pool to be paid to the nursing home.
2            (D) The quality pool is no less than $70,000,000
3        annually or $17,500,000 per quarter.
4            (E) The Department shall review quality metrics
5        used for payment of the quality pool and make
6        recommendations for any associated changes to the
7        methodology for distributing quality pool payments to
8        a quality review committee established by the
9        Department consisting of associations representing
10        long-term care providers, consumer advocates,
11        organizations representing workers of long-term care
12        facilities, and payors.
13            (F) The Department shall disburse quality pool
14        payments from the Long-Term Care Provider Fund on
15        either a monthly or daily basis in amounts
16        proportional to the total quality pool payment
17        determined for the quarter.
18            (G) The Department shall publish any changes in
19        the methodology for distributing quality pool payments
20        prior to the beginning of the measurement period, or
21        quality base period, for any metric added to the
22        distribution's methodology.
23        (2) Payments based on CNA tenure, promotion, and CNA
24    training for the purpose of increasing CNA compensation.
25    It is the intent of this subsection that payments made in
26    accordance with this paragraph be directly incorporated

 

 

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1    into increased compensation for CNAs. As used in this
2    paragraph, "CNA" means a certified nursing assistant as
3    that term is described in Section 3-206 of the Nursing
4    Home Care Act, Section 3-206 of the ID/DD Community Care
5    Act, and Section 3-206 of the MC/DD Act. The Department
6    shall establish, by rule, payments to nursing facilities
7    equal to Medicaid's share of the tenure wage increments
8    specified in this paragraph for all reported CNA employee
9    hours compensated according to a posted schedule
10    consisting of increments at least as large as those
11    specified in this paragraph. The increments are as
12    follows: an additional $1.50 per hour for CNAs with at
13    least one and less than 2 years' experience plus another
14    $1 per hour for each additional year of experience up to a
15    maximum of $6.50 for CNAs with at least 6 years of
16    experience. For purposes of this paragraph, Medicaid's
17    share shall be the ratio determined by paid Medicaid bed
18    days divided by total bed days for the applicable time
19    period used in the calculation. In addition, and additive
20    to any tenure increments paid as specified in this
21    paragraph, the Department shall establish, by rule,
22    payments supporting Medicaid's share of the
23    promotion-based wage increments for CNA employee hours
24    compensated for that promotion with at least a $1.50
25    hourly increase. Medicaid's share shall be established as
26    it is for the tenure increments described in this

 

 

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1    paragraph. Qualifying promotions shall be defined by the
2    Department in rules for an expected 10-15% subset of CNAs
3    assigned intermediate, specialized, or added roles such as
4    CNA trainers, CNA scheduling 'captains', and CNA
5    specialists for resident conditions like dementia or
6    memory care or behavioral health.
7    (m) In order to provide for the expeditious and timely
8implementation of the provisions of this amendatory Act of the
9102nd General Assembly, emergency rules to implement any
10provision of this amendatory Act of the 102nd General Assembly
11may be adopted in accordance with this subsection by the
12agency charged with administering that provision or
13initiative. The 24-month limitation on the adoption of
14emergency rules does not apply to rules adopted under this
15subsection. The adoption of emergency rules authorized by this
16subsection is deemed to be necessary for the public interest,
17safety, and welfare.
18(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
19102-77, eff. 7-9-21; 102-558, eff. 8-20-21.)
 
20    (305 ILCS 5/5B-2)  (from Ch. 23, par. 5B-2)
21    Sec. 5B-2. Assessment; no local authorization to tax.
22    (a) For the privilege of engaging in the occupation of
23long-term care provider, beginning July 1, 2011 through
24December 31, 2021, or upon federal approval by the Centers for
25Medicare and Medicaid Services of the long-term care provider

 

 

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1assessment described in subsection (a-1), whichever is later,
2an assessment is imposed upon each long-term care provider in
3an amount equal to $6.07 times the number of occupied bed days
4due and payable each month. Notwithstanding any provision of
5any other Act to the contrary, this assessment shall be
6construed as a tax, but shall not be billed or passed on to any
7resident of a nursing home operated by the nursing home
8provider.
9    (a-1) For the privilege of engaging in the occupation of
10long-term care provider, beginning January 1, 2022, an
11assessment is imposed upon each long-term care provider in an
12amount varying with the number of paid Medicaid resident days
13per annum in the facility with the following initial schedule
14of occupied bed tax amounts:
15        (1) 0-5,000 Medicaid resident days per annum, $10.67.
16        (2) 5,001-15,000 Medicaid resident days per annum,
17    $19.20.
18        (3) 15,001-35,000 Medicaid resident days per annum,
19    $22.40.
20        (4) 35,001-55,000 Medicaid resident days per annum,
21    $19.20.
22        (5) 55,001-65,000 Medicaid resident days per annum,
23    $13.86.
24        (6) 65,001+ Medicaid resident days per annum, $10.67.
25        (7) Any nonprofit nursing facilities without
26    Medicaid-certified beds, $7 per occupied bed day.

 

 

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1    Notwithstanding any provision of any other Act to the
2contrary, this assessment shall be construed as a tax but
3shall not be billed or passed on to any resident of a nursing
4home operated by the nursing home provider.
5    Each facility's paid Medicaid resident days per annum
6shall be updated annually for the purpose of determining the
7appropriate tax rate.
8    Implementation of the assessment described in this
9subsection shall be subject to federal approval by the Centers
10for Medicare and Medicaid Services.
11    (b) Nothing in this amendatory Act of 1992 shall be
12construed to authorize any home rule unit or other unit of
13local government to license for revenue or impose a tax or
14assessment upon long-term care providers or the occupation of
15long-term care provider, or a tax or assessment measured by
16the income or earnings or occupied bed days of a long-term care
17provider.
18    (c) The assessment imposed by this Section shall not be
19due and payable, however, until after the Department notifies
20the long-term care providers, in writing, that the payment
21methodologies to long-term care providers required under
22Section 5-5.2 5-5.4 of this Code have been approved by the
23Centers for Medicare and Medicaid Services of the U.S.
24Department of Health and Human Services and that the waivers
25under 42 CFR 433.68 for the assessment imposed by this
26Section, if necessary, have been granted by the Centers for

 

 

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1Medicare and Medicaid Services of the U.S. Department of
2Health and Human Services.
3(Source: P.A. 96-1530, eff. 2-16-11; 97-10, eff. 6-14-11;
497-584, eff. 8-26-11.)
 
5    (305 ILCS 5/5B-4)  (from Ch. 23, par. 5B-4)
6    Sec. 5B-4. Payment of assessment; penalty.
7    (a) The assessment imposed by Section 5B-2 shall be due
8and payable monthly, on the last State business day of the
9month for occupied bed days reported for the preceding third
10month prior to the month in which the tax is payable and due. A
11facility that has delayed payment due to the State's failure
12to reimburse for services rendered may request an extension on
13the due date for payment pursuant to subsection (b) and shall
14pay the assessment within 30 days of reimbursement by the
15Department. The Illinois Department may provide that county
16nursing homes directed and maintained pursuant to Section
175-1005 of the Counties Code may meet their assessment
18obligation by certifying to the Illinois Department that
19county expenditures have been obligated for the operation of
20the county nursing home in an amount at least equal to the
21amount of the assessment.
22    (a-5) The Illinois Department shall provide for an
23electronic submission process for each long-term care facility
24to report at a minimum the number of occupied bed days of the
25long-term care facility for the reporting period and other

 

 

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1reasonable information the Illinois Department requires for
2the administration of its responsibilities under this Code.
3Beginning July 1, 2013, a separate electronic submission shall
4be completed for each long-term care facility in this State
5operated by a long-term care provider. The Illinois Department
6shall provide a self-reporting notice of the assessment form
7that the long-term care facility completes for the required
8period and submits with its assessment payment to the Illinois
9Department. To the extent practicable, the Department shall
10coordinate the assessment reporting requirements with other
11reporting required of long-term care facilities.
12    (b) The Illinois Department is authorized to establish
13delayed payment schedules for long-term care providers that
14are unable to make assessment payments when due under this
15Section due to financial difficulties, as determined by the
16Illinois Department. The Illinois Department may not deny a
17request for delay of payment of the assessment imposed under
18this Article if the long-term care provider has not been paid
19for services provided during the month on which the assessment
20is levied or the Medicaid managed care organization has not
21been paid by the State.
22    (c) If a long-term care provider fails to pay the full
23amount of an assessment payment when due (including any
24extensions granted under subsection (b)), there shall, unless
25waived by the Illinois Department for reasonable cause, be
26added to the assessment imposed by Section 5B-2 a penalty

 

 

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1assessment equal to the lesser of (i) 5% of the amount of the
2assessment payment not paid on or before the due date plus 5%
3of the portion thereof remaining unpaid on the last day of each
4month thereafter or (ii) 100% of the assessment payment amount
5not paid on or before the due date. For purposes of this
6subsection, payments will be credited first to unpaid
7assessment payment amounts (rather than to penalty or
8interest), beginning with the most delinquent assessment
9payments. Payment cycles of longer than 60 days shall be one
10factor the Director takes into account in granting a waiver
11under this Section.
12    (c-5) If a long-term care facility fails to file its
13assessment bill with payment, there shall, unless waived by
14the Illinois Department for reasonable cause, be added to the
15assessment due a penalty assessment equal to 25% of the
16assessment due. After July 1, 2013, no penalty shall be
17assessed under this Section if the Illinois Department does
18not provide a process for the electronic submission of the
19information required by subsection (a-5).
20    (d) Nothing in this amendatory Act of 1993 shall be
21construed to prevent the Illinois Department from collecting
22all amounts due under this Article pursuant to an assessment
23imposed before the effective date of this amendatory Act of
241993.
25    (e) Nothing in this amendatory Act of the 96th General
26Assembly shall be construed to prevent the Illinois Department

 

 

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1from collecting all amounts due under this Code pursuant to an
2assessment, tax, fee, or penalty imposed before the effective
3date of this amendatory Act of the 96th General Assembly.
4    (f) No installment of the assessment imposed by Section
55B-2 shall be due and payable until after the Department
6notifies the long-term care providers, in writing, that the
7payment methodologies to long-term care providers required
8under Section 5-5.2 5-5.4 of this Code have been approved by
9the Centers for Medicare and Medicaid Services of the U.S.
10Department of Health and Human Services and the waivers under
1142 CFR 433.68 for the assessment imposed by this Section, if
12necessary, have been granted by the Centers for Medicare and
13Medicaid Services of the U.S. Department of Health and Human
14Services. Upon notification to the Department of approval of
15the payment methodologies required under Section 5-5.2 5-5.4
16of this Code and the waivers granted under 42 CFR 433.68, all
17installments otherwise due under Section 5B-4 prior to the
18date of notification shall be due and payable to the
19Department upon written direction from the Department within
2090 days after issuance by the Comptroller of the payments
21required under Section 5-5.2 5-5.4 of this Code.
22(Source: P.A. 100-501, eff. 6-1-18; 101-649, eff. 7-7-20.)
 
23    (305 ILCS 5/5B-5)  (from Ch. 23, par. 5B-5)
24    Sec. 5B-5. Annual reporting; penalty; maintenance of
25records.

 

 

SB2995- 29 -LRB102 22475 KTG 31615 b

1    (a) After December 31 of each year, and on or before March
231 of the succeeding year, every long-term care provider
3subject to assessment under this Article shall file a report
4with the Illinois Department. The report shall be in a form and
5manner prescribed by the Illinois Department and shall state
6the revenue received by the long-term care provider, reported
7in such categories as may be required by the Illinois
8Department, and other reasonable information the Illinois
9Department requires for the administration of its
10responsibilities under this Code.
11    (b) If a long-term care provider operates or maintains
12more than one long-term care facility in this State, the
13provider may not file a single return covering all those
14long-term care facilities, but shall file a separate return
15for each long-term care facility and shall compute and pay the
16assessment for each long-term care facility separately.
17    (c) Notwithstanding any other provision in this Article,
18in the case of a person who ceases to operate or maintain a
19long-term care facility in respect of which the person is
20subject to assessment under this Article as a long-term care
21provider, the person shall file a final, amended return with
22the Illinois Department not more than 90 days after the
23cessation reflecting the adjustment and shall pay with the
24final return the assessment for the year as so adjusted (to the
25extent not previously paid). If a person fails to file a final
26amended return on a timely basis, there shall, unless waived

 

 

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1by the Illinois Department for reasonable cause, be added to
2the assessment due a penalty assessment equal to 25% of the
3assessment due.
4    (d) Notwithstanding any other provision of this Article, a
5provider who commences operating or maintaining a long-term
6care facility that was under a prior ownership and remained
7licensed by the Department of Public Health shall notify the
8Illinois Department of any the change in ownership regardless
9of percentage, and shall be responsible to immediately pay any
10prior amounts owed by the facility. In addition, within 90
11days after the effective date of this amendatory Act of the
12102nd General Assembly, all providers operating or maintaining
13a long-term care facility shall notify the Illinois Department
14of all individual owners and any individuals or organizations
15that are part of a limited liability company with ownership of
16that facility and the percentage ownership of each owner. This
17ownership reporting requirement does not include individual
18shareholders in a publicly held corporation.
19    (e) The Department shall develop a procedure for sharing
20with a potential buyer of a facility information regarding
21outstanding assessments and penalties owed by that facility.
22    (f) In the case of a long-term care provider existing as a
23corporation or legal entity other than an individual, the
24return filed by it shall be signed by its president,
25vice-president, secretary, or treasurer or by its properly
26authorized agent.

 

 

SB2995- 31 -LRB102 22475 KTG 31615 b

1    (g) If a long-term care provider fails to file its return
2on or before the due date of the return, there shall, unless
3waived by the Illinois Department for reasonable cause, be
4added to the assessment imposed by Section 5B-2 a penalty
5assessment equal to 25% of the assessment imposed for the
6year. After July 1, 2013, no penalty shall be assessed if the
7Illinois Department has not established a process for the
8electronic submission of information.
9    (h) Every long-term care provider subject to assessment
10under this Article shall keep records and books that will
11permit the determination of occupied bed days on a calendar
12year basis. All such books and records shall be kept in the
13English language and shall, at all times during business hours
14of the day, be subject to inspection by the Illinois
15Department or its duly authorized agents and employees.
16    (i) The Illinois Department shall establish a process for
17long-term care providers to electronically submit all
18information required by this Section no later than July 1,
192013.
20(Source: P.A. 96-1530, eff. 2-16-11; 97-403, eff. 1-1-12;
2197-813, eff. 7-13-12.)
 
22    (305 ILCS 5/5B-8)  (from Ch. 23, par. 5B-8)
23    Sec. 5B-8. Long-Term Care Provider Fund.
24    (a) There is created in the State Treasury the Long-Term
25Care Provider Fund. Interest earned by the Fund shall be

 

 

SB2995- 32 -LRB102 22475 KTG 31615 b

1credited to the Fund. The Fund shall not be used to replace any
2moneys appropriated to the Medicaid program by the General
3Assembly.
4    (b) The Fund is created for the purpose of receiving and
5disbursing moneys in accordance with this Article.
6Disbursements from the Fund shall be made only as follows:
7        (1) For payments to nursing facilities, including
8    county nursing facilities but excluding State-operated
9    facilities, under Title XIX of the Social Security Act and
10    Article V of this Code.
11        (1.5) For payments to managed care organizations as
12    defined in Section 5-30.1 of this Code.
13        (2) For the reimbursement of moneys collected by the
14    Illinois Department through error or mistake.
15        (3) For payment of administrative expenses incurred by
16    the Illinois Department or its agent in performing the
17    activities authorized by this Article.
18        (3.5) For reimbursement of expenses incurred by
19    long-term care facilities, and payment of administrative
20    expenses incurred by the Department of Public Health, in
21    relation to the conduct and analysis of background checks
22    for identified offenders under the Nursing Home Care Act.
23        (4) For payments of any amounts that are reimbursable
24    to the federal government for payments from this Fund that
25    are required to be paid by State warrant.
26        (5) For making transfers to the General Obligation

 

 

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1    Bond Retirement and Interest Fund, as those transfers are
2    authorized in the proceedings authorizing debt under the
3    Short Term Borrowing Act, but transfers made under this
4    paragraph (5) shall not exceed the principal amount of
5    debt issued in anticipation of the receipt by the State of
6    moneys to be deposited into the Fund.
7        (6) For making transfers, at the direction of the
8    Director of the Governor's Office of Management and Budget
9    during each fiscal year beginning on or after July 1,
10    2011, to other State funds in an annual amount of
11    $20,000,000 of the tax collected pursuant to this Article
12    for the purpose of enforcement of nursing home standards,
13    support of the ombudsman program, and efforts to expand
14    home and community-based services. No transfer under this
15    paragraph shall occur until (i) the payment methodologies
16    created by Public Act 96-1530 under Section 5-5.4 of this
17    Code have been approved by the Centers for Medicare and
18    Medicaid Services of the U.S. Department of Health and
19    Human Services and (ii) the assessment imposed by Section
20    5B-2 of this Code is determined to be a permissible tax
21    under Title XIX of the Social Security Act.
22    Disbursements from the Fund, other than transfers made
23pursuant to paragraphs (5) and (6) of this subsection, shall
24be by warrants drawn by the State Comptroller upon receipt of
25vouchers duly executed and certified by the Illinois
26Department.

 

 

SB2995- 34 -LRB102 22475 KTG 31615 b

1    (c) The Fund shall consist of the following:
2        (1) All moneys collected or received by the Illinois
3    Department from the long-term care provider assessment
4    imposed by this Article.
5        (2) All federal matching funds received by the
6    Illinois Department as a result of expenditures made from
7    the Fund by the Illinois Department that are attributable
8    to moneys deposited in the Fund.
9        (3) Any interest or penalty levied in conjunction with
10    the administration of this Article.
11        (4) (Blank).
12        (5) All other monies received for the Fund from any
13    other source, including interest earned thereon.
14(Source: P.A. 96-1530, eff. 2-16-11; 97-584, eff. 8-26-11.)
 
15    (305 ILCS 5/5E-10)
16    Sec. 5E-10. Fee. Through December 31, 2021 or upon federal
17approval by the Centers for Medicare and Medicaid Services of
18the long-term care provider assessment described in subsection
19(a-1) of Section 5B-2 of this Code, whichever is later, every
20Every nursing home provider shall pay to the Illinois
21Department, on or before September 10, December 10, March 10,
22and June 10, a fee in the amount of $1.50 for each licensed
23nursing bed day for the calendar quarter in which the payment
24is due. This fee shall not be billed or passed on to any
25resident of a nursing home operated by the nursing home

 

 

SB2995- 35 -LRB102 22475 KTG 31615 b

1provider. All fees received by the Illinois Department under
2this Section shall be deposited into the Long-Term Care
3Provider Fund. This Section 5E-10 is repealed on December 31,
42023.
5(Source: P.A. 88-88; 89-21, eff. 7-1-95.)
 
6    (305 ILCS 5/5E-20 new)
7    Sec. 5E-20. Repealer. This Article 5E is repealed on July
81, 2024.

 

 

SB2995- 36 -LRB102 22475 KTG 31615 b

1 INDEX
2 Statutes amended in order of appearance
3    5 ILCS 100/5-45.20 new
4    225 ILCS 510/3from Ch. 111, par. 953
5    225 ILCS 510/14from Ch. 111, par. 964
6    305 ILCS 5/5-5.2from Ch. 23, par. 5-5.2
7    305 ILCS 5/5B-2from Ch. 23, par. 5B-2
8    305 ILCS 5/5B-4from Ch. 23, par. 5B-4
9    305 ILCS 5/5B-5from Ch. 23, par. 5B-5
10    305 ILCS 5/5B-8from Ch. 23, par. 5B-8
11    305 ILCS 5/5E-10
12    305 ILCS 5/5E-20 new