Full Text of HB4032 94th General Assembly
HB4032ham001 94TH GENERAL ASSEMBLY
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Developmental Disabilities and Mental Illness Committee
Filed: 3/10/2005
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09400HB4032ham001 |
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LRB094 09950 DRJ 43560 a |
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| AMENDMENT TO HOUSE BILL 4032
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| AMENDMENT NO. ______. Amend House Bill 4032 by replacing | 3 |
| everything after the enacting clause with the following:
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| "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)
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| 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:
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| (1) Provide for the determination of a facility's payment
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| for skilled nursing and intermediate care services on a | 13 |
| prospective basis.
The amount of the payment rate for all | 14 |
| nursing facilities certified by the
Department of Public Health | 15 |
| under the Nursing Home Care Act as Intermediate
Care for the | 16 |
| Developmentally Disabled facilities, Long Term Care for Under | 17 |
| Age
22 facilities, Skilled Nursing facilities, or Intermediate | 18 |
| Care facilities
under the
medical assistance program shall be | 19 |
| prospectively established annually on the
basis of historical, | 20 |
| financial, and statistical data reflecting actual costs
from | 21 |
| prior years, which shall be applied to the current rate year | 22 |
| and updated
for inflation, except that the capital cost element | 23 |
| for newly constructed
facilities shall be based upon projected | 24 |
| budgets. The annually established
payment rate shall take |
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| effect on July 1 in 1984 and subsequent years. No rate
increase | 2 |
| and no
update for inflation shall be provided on or after July | 3 |
| 1, 1994 and before
July 1, 2005, unless specifically provided | 4 |
| for in this
Section.
The changes made by this amendatory Act of | 5 |
| the 93rd General Assembly extending the duration of the | 6 |
| prohibition against a rate increase or update for inflation are | 7 |
| effective retroactive to July 1, 2004.
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| For facilities licensed by the Department of Public Health | 9 |
| under the Nursing
Home Care Act as Intermediate Care for the | 10 |
| Developmentally Disabled facilities
or Long Term Care for Under | 11 |
| Age 22 facilities, the rates taking effect on July
1, 1998 | 12 |
| shall include an increase of 3%. For facilities licensed by the
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| Department of Public Health under the Nursing Home Care Act as | 14 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 15 |
| the rates taking effect on July 1,
1998 shall include an | 16 |
| increase of 3% plus $1.10 per resident-day, as defined by
the | 17 |
| Department.
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| For facilities licensed by the Department of Public Health | 19 |
| under the
Nursing Home Care Act as Intermediate Care for the | 20 |
| Developmentally Disabled
facilities or Long Term Care for Under | 21 |
| Age 22 facilities, the rates taking
effect on July 1, 1999 | 22 |
| shall include an increase of 1.6% plus $3.00 per
resident-day, | 23 |
| as defined by the Department. For facilities licensed by the
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| Department of Public Health under the Nursing Home Care Act as | 25 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 26 |
| the rates taking effect on July 1,
1999 shall include an | 27 |
| increase of 1.6% and, for services provided on or after
October | 28 |
| 1, 1999, shall be increased by $4.00 per resident-day, as | 29 |
| defined by
the Department.
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| For facilities licensed by the Department of Public Health | 31 |
| under the
Nursing Home Care Act as Intermediate Care for the | 32 |
| Developmentally Disabled
facilities or Long Term Care for Under | 33 |
| Age 22 facilities, the rates taking
effect on July 1, 2000 | 34 |
| shall include an increase of 2.5% per resident-day,
as defined |
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LRB094 09950 DRJ 43560 a |
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| by the Department. For facilities licensed by the Department of
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| Public Health under the Nursing Home Care Act as Skilled | 3 |
| Nursing facilities or
Intermediate Care facilities, the rates | 4 |
| taking effect on July 1, 2000 shall
include an increase of 2.5% | 5 |
| per resident-day, as defined by the Department.
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| For facilities licensed by the Department of Public Health | 7 |
| under the
Nursing Home Care Act as skilled nursing facilities | 8 |
| or intermediate care
facilities, a new payment methodology must | 9 |
| be implemented for the nursing
component of the rate effective | 10 |
| July 1, 2003. The Department of Public Aid
shall develop the | 11 |
| new payment methodology using the Minimum Data Set
(MDS) as the | 12 |
| instrument to collect information concerning nursing home
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| resident condition necessary to compute the rate. The | 14 |
| Department of Public Aid
shall develop the new payment | 15 |
| methodology to meet the unique needs of
Illinois nursing home | 16 |
| residents while remaining subject to the appropriations
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| provided by the General Assembly.
A transition period from the | 18 |
| payment methodology in effect on June 30, 2003
to the payment | 19 |
| methodology in effect on July 1, 2003 shall be provided for a
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| period not exceeding 2 years after implementation of the new | 21 |
| payment
methodology as follows:
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| (A) For a facility that would receive a lower
nursing | 23 |
| component rate per patient day under the new system than | 24 |
| the facility
received
effective on the date immediately | 25 |
| preceding the date that the Department
implements the new | 26 |
| payment methodology, the nursing component rate per | 27 |
| patient
day for the facility
shall be held at
the level in | 28 |
| effect on the date immediately preceding the date that the
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| Department implements the new payment methodology until a | 30 |
| higher nursing
component rate of
reimbursement is achieved | 31 |
| by that
facility.
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| (B) For a facility that would receive a higher nursing | 33 |
| component rate per
patient day under the payment | 34 |
| methodology in effect on July 1, 2003 than the
facility |
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| received effective on the date immediately preceding the | 2 |
| date that the
Department implements the new payment | 3 |
| methodology, the nursing component rate
per patient day for | 4 |
| the facility shall be adjusted.
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| (C) Notwithstanding paragraphs (A) and (B), the | 6 |
| nursing component rate per
patient day for the facility | 7 |
| shall be adjusted subject to appropriations
provided by the | 8 |
| General Assembly.
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| For facilities licensed by the Department of Public Health | 10 |
| under the
Nursing Home Care Act as Intermediate Care for the | 11 |
| Developmentally Disabled
facilities or Long Term Care for Under | 12 |
| Age 22 facilities, the rates taking
effect on March 1, 2001 | 13 |
| shall include a statewide increase of 7.85%, as
defined by the | 14 |
| Department.
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| For facilities licensed by the Department of Public Health | 16 |
| under the
Nursing Home Care Act as Intermediate Care for the | 17 |
| Developmentally Disabled
facilities or Long Term Care for Under | 18 |
| Age 22 facilities, the rates taking
effect on April 1, 2002 | 19 |
| shall include a statewide increase of 2.0%, as
defined by the | 20 |
| Department.
This increase terminates on July 1, 2002;
beginning | 21 |
| July 1, 2002 these rates are reduced to the level of the rates
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| in effect on March 31, 2002, as defined by the Department.
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| For facilities licensed by the Department of Public Health | 24 |
| under the
Nursing Home Care Act as skilled nursing facilities | 25 |
| or intermediate care
facilities, the rates taking effect on | 26 |
| July 1, 2001 shall be computed using the most recent cost | 27 |
| reports
on file with the Department of Public Aid no later than | 28 |
| April 1, 2000,
updated for inflation to January 1, 2001. For | 29 |
| rates effective July 1, 2001
only, rates shall be the greater | 30 |
| of the rate computed for July 1, 2001
or the rate effective on | 31 |
| June 30, 2001.
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| Notwithstanding any other provision of this Section, for | 33 |
| facilities
licensed by the Department of Public Health under | 34 |
| the Nursing Home Care Act
as skilled nursing facilities or |
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| intermediate care facilities, the Illinois
Department shall | 2 |
| determine by rule the rates taking effect on July 1, 2002,
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| which shall be 5.9% less than the rates in effect on June 30, | 4 |
| 2002.
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| Notwithstanding any other provision of this Section, for | 6 |
| facilities
licensed by the Department of Public Health under | 7 |
| the Nursing Home Care Act as
skilled nursing
facilities or | 8 |
| intermediate care facilities, if the payment methodologies | 9 |
| required under Section 5A-12 and the waiver granted under 42 | 10 |
| CFR 433.68 are approved by the United States Centers for | 11 |
| Medicare and Medicaid Services, the rates taking effect on July | 12 |
| 1, 2004 shall be 3.0% greater than the rates in effect on June | 13 |
| 30, 2004. These rates shall take
effect only upon approval and
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| implementation of the payment methodologies required under | 15 |
| Section 5A-12.
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| Notwithstanding any other provisions of this Section, for | 17 |
| facilities licensed by the Department of Public Health under | 18 |
| the Nursing Home Care Act as skilled nursing facilities or | 19 |
| intermediate care facilities, the rates taking effect on | 20 |
| January 1, 2005 shall be 3% more than the rates in effect on | 21 |
| December 31, 2004.
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| For facilities
licensed
by the
Department of Public Health | 23 |
| under the Nursing Home Care Act as Intermediate
Care for
the | 24 |
| Developmentally Disabled facilities or as long-term care | 25 |
| facilities for
residents under 22 years of age, the rates | 26 |
| taking effect on July 1,
2003 shall
include a statewide | 27 |
| increase of 4%, as defined by the Department.
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| Notwithstanding any other provision of this Section, for | 29 |
| facilities licensed by the Department of Public Health under | 30 |
| the Nursing Home Care Act as skilled nursing facilities or | 31 |
| intermediate care facilities, effective January 1, 2005, | 32 |
| facility rates shall be increased by the difference between (i) | 33 |
| a facility's per diem property, liability, and malpractice | 34 |
| insurance costs as reported in the cost report filed with the |
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| Department of Public Aid and used to establish rates effective | 2 |
| July 1, 2001 and (ii) those same costs as reported in the | 3 |
| facility's 2002 cost report. These costs shall be passed | 4 |
| through to the facility without caps or limitations, except for | 5 |
| adjustments required under normal auditing procedures.
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| Notwithstanding any other provision of this Section, for | 7 |
| facilities licensed by the Department of Public Health under | 8 |
| the Nursing Home Care Act as Intermediate Care for the | 9 |
| Developmentally Disabled facilities or Long Term Care for Under | 10 |
| Age 22 facilities, effective January 1, 2006, facility rates | 11 |
| shall be increased by the difference between (i) a facility's | 12 |
| per diem property, liability, and malpractice insurance costs | 13 |
| as reported in the cost report filed with the Department of | 14 |
| Public Aid and used to establish rates effective July 1, 2001 | 15 |
| and (ii) those same costs as reported in the facility's 2002 | 16 |
| cost report. These costs shall be passed through to the | 17 |
| facility without caps or limitations, except for adjustments | 18 |
| required under normal auditing procedures.
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| Rates established effective each July 1 shall govern | 20 |
| payment
for services rendered throughout that fiscal year, | 21 |
| except that rates
established on July 1, 1996 shall be | 22 |
| increased by 6.8% for services
provided on or after January 1, | 23 |
| 1997. Such rates will be based
upon the rates calculated for | 24 |
| the year beginning July 1, 1990, and for
subsequent years | 25 |
| thereafter until June 30, 2001 shall be based on the
facility | 26 |
| cost reports
for the facility fiscal year ending at any point | 27 |
| in time during the previous
calendar year, updated to the | 28 |
| midpoint of the rate year. The cost report
shall be on file | 29 |
| with the Department no later than April 1 of the current
rate | 30 |
| year. Should the cost report not be on file by April 1, the | 31 |
| Department
shall base the rate on the latest cost report filed | 32 |
| by each skilled care
facility and intermediate care facility, | 33 |
| updated to the midpoint of the
current rate year. In | 34 |
| determining rates for services rendered on and after
July 1, |
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| 1985, fixed time shall not be computed at less than zero. The
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| Department shall not make any alterations of regulations which | 3 |
| would reduce
any component of the Medicaid rate to a level | 4 |
| below what that component would
have been utilizing in the rate | 5 |
| effective on July 1, 1984.
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| (2) Shall take into account the actual costs incurred by | 7 |
| facilities
in providing services for recipients of skilled | 8 |
| nursing and intermediate
care services under the medical | 9 |
| assistance program.
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| (3) Shall take into account the medical and psycho-social
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| characteristics and needs of the patients.
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| (4) Shall take into account the actual costs incurred by | 13 |
| facilities in
meeting licensing and certification standards | 14 |
| imposed and prescribed by the
State of Illinois, any of its | 15 |
| political subdivisions or municipalities and by
the U.S. | 16 |
| Department of Health and Human Services pursuant to Title XIX | 17 |
| of the
Social Security Act.
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| The Department of Public Aid shall develop precise | 19 |
| standards for
payments to reimburse nursing facilities for any | 20 |
| utilization of
appropriate rehabilitative personnel for the | 21 |
| provision of rehabilitative
services which is authorized by | 22 |
| federal regulations, including
reimbursement for services | 23 |
| provided by qualified therapists or qualified
assistants, and | 24 |
| which is in accordance with accepted professional
practices. | 25 |
| Reimbursement also may be made for utilization of other
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| supportive personnel under appropriate supervision.
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| (Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597, | 28 |
| eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20, | 29 |
| eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, eff. 2-3-04; 93-841, | 30 |
| eff. 7-30-04; 93-1087, eff. 2-28-05.)
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| Section 10. The Community Services Act is amended by | 32 |
| changing Section 4 as follows:
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| (405 ILCS 30/4) (from Ch. 91 1/2, par. 904)
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| Sec. 4. Financing for Community Services. The Department of | 3 |
| Human Services
is authorized to
provide financial assistance to | 4 |
| eligible private service providers,
corporations, local | 5 |
| government entities or voluntary associations for the
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| provision of services to persons with mental illness, persons | 7 |
| with a
developmental disability and alcohol and drug dependent | 8 |
| persons living in the
community for the purpose of achieving | 9 |
| the goals of this Act.
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| The Department shall utilize the following funding | 11 |
| mechanisms for community
services:
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| (1) Purchase of Care Contracts: services purchased on a | 13 |
| predetermined fee
per unit of service basis from private | 14 |
| providers or governmental entities. Fee
per service rates | 15 |
| are set by an established formula which covers some portion
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| of personnel, supplies, and other allowable costs, and | 17 |
| which makes some
allowance for geographic variations in | 18 |
| costs as well as for additional program
components.
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| (2) Grants: sums of money which the Department grants | 20 |
| to private providers or
governmental
entities pursuant to | 21 |
| the grant recipient's agreement to provide certain
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| services, as defined by departmental grant guidelines, to | 23 |
| an
approximate number of service
recipients. Grant levels | 24 |
| are set through consideration of personnel, supply and
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| other allowable costs, as well as other funds available to | 26 |
| the program.
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| (3) Other Funding Arrangements: funding mechanisms may | 28 |
| be established
on a pilot basis in order to examine the | 29 |
| feasibility of alternative financing
arrangements for the | 30 |
| provision of community services.
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| The Department shall strive to establish and maintain an | 32 |
| equitable system of
payment
which encourages providers to | 33 |
| improve their clients' capabilities for
independence and | 34 |
| reduces their reliance on community or State-operated
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| services. In accepting Department funds, providers shall | 2 |
| recognize
their responsibility to be
accountable to the | 3 |
| Department and the State for the delivery of services
which are | 4 |
| consistent
with the philosophies and goals of this Act and the | 5 |
| rules and regulations
promulgated under it. | 6 |
| For providers from which the Department of Human Services | 7 |
| purchases services under this Section, effective January 1, | 8 |
| 2006, payment rates shall be increased by the difference | 9 |
| between (i) a provider's per diem property, liability, and | 10 |
| malpractice insurance costs effective July 1, 2001 and (ii) | 11 |
| those same costs effective July 1, 2002. These costs shall be | 12 |
| passed through to the provider without caps or limitations, | 13 |
| except for adjustments required under normal auditing | 14 |
| procedures.
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| (Source: P.A. 88-380; 89-507, eff. 7-1-97.)
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| Section 99. Effective date. This Act takes effect upon | 17 |
| becoming law.".
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