093_HB2657sam001











                                     LRB093 04135 SJM 20285 a

 1                    AMENDMENT TO HOUSE BILL 2657

 2        AMENDMENT NO.     .  Amend House Bill 2657  by  replacing
 3    everything after the enacting clause with the following:

 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  Public
 8    Aid.  The Department of Public Aid shall develop standards of
 9    payment of skilled nursing and intermediate care services  in
10    facilities providing such services under this Article which:
11        (1)  Provide   for  the  determination  of  a  facility's
12    payment for skilled nursing and intermediate care services on
13    a prospective basis. The amount of the payment rate  for  all
14    nursing  facilities  certified  by  the  Department of Public
15    Health under the Nursing Home Care Act as  Intermediate  Care
16    for  the  Developmentally Disabled facilities, Long Term Care
17    for Under Age 22 facilities, Skilled Nursing  facilities,  or
18    Intermediate  Care  facilities  under  the medical assistance
19    program shall be prospectively established  annually  on  the
20    basis   of   historical,   financial,  and  statistical  data
21    reflecting actual costs from  prior  years,  which  shall  be
22    applied  to  the current rate year and updated for inflation,
 
                            -2-      LRB093 04135 SJM 20285 a
 1    except that the capital cost element  for  newly  constructed
 2    facilities  shall  be  based  upon  projected  budgets.   The
 3    annually established payment rate shall take effect on July 1
 4    in 1984 and subsequent years.  No rate increase and no update
 5    for  inflation shall be provided on or after July 1, 1994 and
 6    before July 1, 2004, unless specifically provided for in this
 7    Section.
 8        For facilities  licensed  by  the  Department  of  Public
 9    Health  under  the Nursing Home Care Act as Intermediate Care
10    for the Developmentally Disabled facilities or Long Term Care
11    for Under Age 22 facilities, the rates taking effect on  July
12    1,  1998  shall  include  an  increase of 3%.  For facilities
13    licensed by the Department of Public Health under the Nursing
14    Home Care Act as Skilled Nursing facilities  or  Intermediate
15    Care  facilities,  the  rates  taking  effect on July 1, 1998
16    shall include an increase of 3% plus $1.10 per  resident-day,
17    as defined by the Department.
18        For  facilities  licensed  by  the  Department  of Public
19    Health under the Nursing Home Care Act as  Intermediate  Care
20    for the Developmentally Disabled facilities or Long Term Care
21    for  Under Age 22 facilities, the rates taking effect on July
22    1, 1999 shall include an increase  of  1.6%  plus  $3.00  per
23    resident-day,  as  defined by the Department.  For facilities
24    licensed by the Department of Public Health under the Nursing
25    Home Care Act as Skilled Nursing facilities  or  Intermediate
26    Care  facilities,  the  rates  taking  effect on July 1, 1999
27    shall include an increase of 1.6% and, for services  provided
28    on  or after October 1, 1999, shall be increased by $4.00 per
29    resident-day, as defined by the Department.
30        For facilities  licensed  by  the  Department  of  Public
31    Health  under  the Nursing Home Care Act as Intermediate Care
32    for the Developmentally Disabled facilities or Long Term Care
33    for Under Age 22 facilities, the rates taking effect on  July
34    1,  2000  shall include an increase of 2.5% per resident-day,
 
                            -3-      LRB093 04135 SJM 20285 a
 1    as defined by the Department.  For facilities licensed by the
 2    Department of Public Health under the Nursing Home  Care  Act
 3    as   Skilled   Nursing   facilities   or   Intermediate  Care
 4    facilities, the rates taking effect on  July  1,  2000  shall
 5    include  an  increase of 2.5% per resident-day, as defined by
 6    the Department.
 7        For facilities  licensed  by  the  Department  of  Public
 8    Health  under  the  Nursing  Home Care Act as skilled nursing
 9    facilities or intermediate care  facilities,  a  new  payment
10    methodology  must be implemented for the nursing component of
11    the rate effective July 1, 2003. The Department of Public Aid
12    shall develop the new payment methodology using  the  Minimum
13    Data  Set  (MDS)  as  the  instrument  to collect information
14    concerning  nursing  home  resident  condition  necessary  to
15    compute the rate. The Department of Public Aid shall  develop
16    the  new  payment  methodology  to  meet  the unique needs of
17    Illinois nursing home residents while  remaining  subject  to
18    the  appropriations  provided  by  the  General  Assembly.  A
19    transition  period  from the payment methodology in effect on
20    June 30, 2003 to the payment methodology in effect on July 1,
21    2003 shall be provided for a period  not  exceeding  2  years
22    after  implementation  of  the  new  payment  methodology  as
23    follows:
24             (A)  For  a  facility  that  would  receive  a lower
25        nursing component rate per  patient  day  under  the  new
26        system  than  the facility received effective on the date
27        immediately  preceding  the  date  that  the   Department
28        implements  the  new  payment  methodology,  the  nursing
29        component  rate per patient day for the facility shall be
30        held at the level  in  effect  on  the  date  immediately
31        preceding the date that the Department implements the new
32        payment methodology until a higher nursing component rate
33        of reimbursement is achieved by that facility.
34             (B)  For  a  facility  that  would  receive a higher
 
                            -4-      LRB093 04135 SJM 20285 a
 1        nursing component rate per patient day under the  payment
 2        methodology  in  effect on July 1, 2003 than the facility
 3        received effective on the date immediately preceding  the
 4        date  that  the  Department  implements  the  new payment
 5        methodology, the nursing component rate per  patient  day
 6        for the facility shall be adjusted.
 7             (C)  Notwithstanding  paragraphs  (A)  and  (B), the
 8        nursing component rate per patient day for  the  facility
 9        shall  be  adjusted subject to appropriations provided by
10        the General Assembly.
11        For facilities  licensed  by  the  Department  of  Public
12    Health  under  the Nursing Home Care Act as Intermediate Care
13    for the Developmentally Disabled facilities or Long Term Care
14    for Under Age 22 facilities, the rates taking effect on March
15    1, 2001 shall include  a  statewide  increase  of  7.85%,  as
16    defined by the Department.
17        For  facilities  licensed  by  the  Department  of Public
18    Health under the Nursing Home Care Act as  Intermediate  Care
19    for the Developmentally Disabled facilities or Long Term Care
20    for Under Age 22 facilities, the rates taking effect on April
21    1,  2002  shall  include  a  statewide  increase  of 2.0%, as
22    defined by the Department. This increase terminates  on  July
23    1,  2002;  beginning  July 1, 2002 these rates are reduced to
24    the level of the rates  in  effect  on  March  31,  2002,  as
25    defined by the Department.
26        For  facilities  licensed  by  the  Department  of Public
27    Health under the Nursing Home Care  Act  as  skilled  nursing
28    facilities  or intermediate care facilities, the rates taking
29    effect on July 1, 2001  shall  be  computed  using  the  most
30    recent cost reports on file with the Department of Public Aid
31    no later than April 1, 2000, updated for inflation to January
32    1,  2001.  For rates effective July 1, 2001 only, rates shall
33    be the greater of the rate computed for July 1, 2001  or  the
34    rate effective on June 30, 2001.
 
                            -5-      LRB093 04135 SJM 20285 a
 1        Notwithstanding  any other provision of this Section, for
 2    facilities licensed by the Department of Public Health  under
 3    the  Nursing  Home  Care Act as skilled nursing facilities or
 4    intermediate care facilities, the Illinois  Department  shall
 5    determine  by  rule  the rates taking effect on July 1, 2002,
 6    which shall be 5.9% less than the rates in effect on June 30,
 7    2002.
 8        For facilities  licensed  by  the  Department  of  Public
 9    Health  under  the Nursing Home Care Act as Intermediate Care
10    for the Developmentally Disabled facilities or  as  long-term
11    care  facilities  for  residents  under  22 years of age, the
12    rates taking effect on July 1, 2003 shall include a statewide
13    increase of 4%, as defined by the Department.
14        Rates established effective  each  July  1  shall  govern
15    payment  for  services  rendered throughout that fiscal year,
16    except that rates  established  on  July  1,  1996  shall  be
17    increased  by  6.8% for services provided on or after January
18    1, 1997.  Such rates will be based upon the rates  calculated
19    for the year beginning July 1, 1990, and for subsequent years
20    thereafter until June 30, 2001 shall be based on the facility
21    cost reports for the facility fiscal year ending at any point
22    in  time  during  the  previous calendar year, updated to the
23    midpoint of the rate year.  The cost report shall be on  file
24    with the Department no later than April 1 of the current rate
25    year.   Should the cost report not be on file by April 1, the
26    Department shall base the rate  on  the  latest  cost  report
27    filed  by  each  skilled  care facility and intermediate care
28    facility, updated to the midpoint of the current  rate  year.
29    In  determining rates for services rendered on and after July
30    1, 1985, fixed time shall not be computed at less than  zero.
31    The  Department shall not make any alterations of regulations
32    which would reduce any component of the Medicaid  rate  to  a
33    level  below what that component would have been utilizing in
34    the rate effective on July 1, 1984.
 
                            -6-      LRB093 04135 SJM 20285 a
 1        (2)  Shall take into account the actual costs incurred by
 2    facilities in providing services for  recipients  of  skilled
 3    nursing  and  intermediate  care  services  under the medical
 4    assistance program.
 5        (3)  Shall   take   into   account   the   medical    and
 6    psycho-social characteristics and needs of the patients.
 7        (4)  Shall take into account the actual costs incurred by
 8    facilities  in  meeting licensing and certification standards
 9    imposed and prescribed by the State of Illinois, any  of  its
10    political  subdivisions  or  municipalities  and  by the U.S.
11    Department of Health and Human Services pursuant to Title XIX
12    of the Social Security Act.
13        The  Department  of  Public  Aid  shall  develop  precise
14    standards for payments to reimburse  nursing  facilities  for
15    any  utilization  of appropriate rehabilitative personnel for
16    the provision of rehabilitative services which is  authorized
17    by  federal regulations, including reimbursement for services
18    provided by qualified therapists or qualified assistants, and
19    which is in accordance with accepted professional  practices.
20    Reimbursement  also  may  be  made  for  utilization of other
21    supportive personnel under appropriate supervision.
22    (Source: P.A.  92-10,  eff.  6-11-01;  92-31,  eff.  6-28-01;
23    92-597,  eff.  6-28-02;  92-651,  eff.  7-11-02; 92-848, eff.
24    1-1-03; 93-20, eff. 6-20-03.)

25        Section 99.  Effective date.  This Act takes effect  upon
26    becoming law.".