Full Text of HB0662 96th General Assembly
HB0662eng 96TH GENERAL ASSEMBLY
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| AN ACT concerning health.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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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 Healthcare | 8 |
| and Family Services.
The The Department of Healthcare and | 9 |
| Family Services shall develop standards of payment of skilled
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| nursing and intermediate care services in facilities providing | 11 |
| 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 | 14 |
| prospective basis.
The amount of the payment rate for all | 15 |
| nursing facilities certified by the
Department of Public Health | 16 |
| under the Nursing Home Care Act as Intermediate
Care for the | 17 |
| Developmentally Disabled facilities, Long Term Care for Under | 18 |
| Age
22 facilities, Skilled Nursing facilities, or Intermediate | 19 |
| Care facilities
under the
medical assistance program shall be | 20 |
| prospectively established annually on the
basis of historical, | 21 |
| financial, and statistical data reflecting actual costs
from | 22 |
| prior years, which shall be applied to the current rate year | 23 |
| and updated
for inflation, except that the capital cost element |
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| for newly constructed
facilities shall be based upon projected | 2 |
| budgets. The annually established
payment rate shall take | 3 |
| effect on July 1 in 1984 and subsequent years. No rate
increase | 4 |
| and no
update for inflation shall be provided on or after July | 5 |
| 1, 1994 and before
July 1, 2009, unless specifically provided | 6 |
| for in this
Section.
The changes made by Public Act 93-841
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| extending the duration of the prohibition against a rate | 8 |
| increase or update for inflation are effective retroactive to | 9 |
| July 1, 2004.
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| For facilities licensed by the Department of Public Health | 11 |
| under the Nursing
Home Care Act as Intermediate Care for the | 12 |
| Developmentally Disabled facilities
or Long Term Care for Under | 13 |
| Age 22 facilities, the rates taking effect on July
1, 1998 | 14 |
| 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 | 16 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 17 |
| the rates taking effect on July 1,
1998 shall include an | 18 |
| increase of 3% plus $1.10 per resident-day, as defined by
the | 19 |
| Department. For facilities licensed by the Department of Public | 20 |
| Health under the Nursing Home Care Act as Intermediate Care | 21 |
| Facilities for the Developmentally Disabled or Long Term Care | 22 |
| for Under Age 22 facilities, the rates taking effect on January | 23 |
| 1, 2006 shall include an increase of 3%.
For facilities | 24 |
| licensed by the Department of Public Health under the Nursing | 25 |
| Home Care Act as Intermediate Care Facilities for the | 26 |
| Developmentally Disabled or Long Term Care for Under Age 22 |
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| facilities, the rates taking effect on January 1, 2009 shall | 2 |
| include an increase sufficient to provide a $0.50 per hour wage | 3 |
| increase for non-executive staff.
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| For facilities licensed by the Department of Public Health | 5 |
| under the
Nursing Home Care Act as Intermediate Care for the | 6 |
| Developmentally Disabled
facilities or Long Term Care for Under | 7 |
| Age 22 facilities, the rates taking
effect on July 1, 1999 | 8 |
| shall include an increase of 1.6% plus $3.00 per
resident-day, | 9 |
| 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 | 11 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 12 |
| the rates taking effect on July 1,
1999 shall include an | 13 |
| increase of 1.6% and, for services provided on or after
October | 14 |
| 1, 1999, shall be increased by $4.00 per resident-day, as | 15 |
| defined by
the Department.
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| For facilities licensed by the Department of Public Health | 17 |
| under the
Nursing Home Care Act as Intermediate Care for the | 18 |
| Developmentally Disabled
facilities or Long Term Care for Under | 19 |
| Age 22 facilities, the rates taking
effect on July 1, 2000 | 20 |
| shall include an increase of 2.5% per resident-day,
as defined | 21 |
| by the Department. For facilities licensed by the Department of
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| Public Health under the Nursing Home Care Act as Skilled | 23 |
| Nursing facilities or
Intermediate Care facilities, the rates | 24 |
| taking effect on July 1, 2000 shall
include an increase of 2.5% | 25 |
| per resident-day, as defined by the Department.
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| For facilities licensed by the Department of Public Health |
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| under the
Nursing Home Care Act as skilled nursing facilities | 2 |
| or intermediate care
facilities, a new payment methodology must | 3 |
| be implemented for the nursing
component of the rate effective | 4 |
| July 1, 2003. The Department of Public Aid
(now Healthcare and | 5 |
| Family Services) shall develop the new payment methodology | 6 |
| using the Minimum Data Set
(MDS) as the instrument to collect | 7 |
| information concerning nursing home
resident condition | 8 |
| necessary to compute the rate. The Department
shall develop the | 9 |
| new payment methodology to meet the unique needs of
Illinois | 10 |
| nursing home residents while remaining subject to the | 11 |
| appropriations
provided by the General Assembly.
A transition | 12 |
| period from the payment methodology in effect on June 30, 2003
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| to the payment methodology in effect on July 1, 2003 shall be | 14 |
| provided for a
period not exceeding 3 years and 184 days after | 15 |
| implementation of the new payment
methodology as follows:
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| (A) For a facility that would receive a lower
nursing | 17 |
| component rate per patient day under the new system than | 18 |
| the facility
received
effective on the date immediately | 19 |
| preceding the date that the Department
implements the new | 20 |
| payment methodology, the nursing component rate per | 21 |
| patient
day for the facility
shall be held at
the level in | 22 |
| effect on the date immediately preceding the date that the
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| Department implements the new payment methodology until a | 24 |
| higher nursing
component rate of
reimbursement is achieved | 25 |
| by that
facility.
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| (B) For a facility that would receive a higher nursing |
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| 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 for | 6 |
| the facility shall be adjusted.
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| (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 the | 10 |
| General Assembly.
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| For facilities licensed by the Department of Public Health | 12 |
| under the
Nursing Home Care Act as Intermediate Care for the | 13 |
| Developmentally Disabled
facilities or Long Term Care for Under | 14 |
| Age 22 facilities, the rates taking
effect on March 1, 2001 | 15 |
| shall include a statewide increase of 7.85%, as
defined by the | 16 |
| Department.
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| Notwithstanding any other provision of this Section, for | 18 |
| facilities licensed by the Department of Public Health under | 19 |
| the
Nursing Home Care Act as skilled nursing facilities or | 20 |
| intermediate care
facilities, the numerator of the ratio used | 21 |
| by the Department of Healthcare and Family Services to compute | 22 |
| the rate payable under this Section using the Minimum Data Set | 23 |
| (MDS) methodology shall incorporate the following annual | 24 |
| amounts as the additional funds appropriated to the Department | 25 |
| specifically to pay for rates based on the MDS nursing | 26 |
| component methodology in excess of the funding in effect on |
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| December 31, 2006: | 2 |
| (i) For rates taking effect January 1, 2007, | 3 |
| $60,000,000. | 4 |
| (ii) For rates taking effect January 1, 2008, | 5 |
| $110,000,000. | 6 |
| (iii) For rates taking effect January 1, 2009, | 7 |
| $194,000,000. | 8 |
| Notwithstanding any other provision of this Section, for | 9 |
| facilities licensed by the Department of Public Health under | 10 |
| the Nursing Home Care Act as skilled nursing facilities or | 11 |
| intermediate care facilities, the support component of the | 12 |
| rates taking effect on January 1, 2008 shall be computed using | 13 |
| the most recent cost reports on file with the Department of | 14 |
| Healthcare and Family Services no later than April 1, 2005, | 15 |
| updated for inflation to January 1, 2006. | 16 |
| For facilities licensed by the Department of Public Health | 17 |
| under the
Nursing Home Care Act as Intermediate Care for the | 18 |
| Developmentally Disabled
facilities or Long Term Care for Under | 19 |
| Age 22 facilities, the rates taking
effect on April 1, 2002 | 20 |
| shall include a statewide increase of 2.0%, as
defined by the | 21 |
| Department.
This increase terminates on July 1, 2002;
beginning | 22 |
| 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 | 25 |
| under the
Nursing Home Care Act as skilled nursing facilities | 26 |
| or intermediate care
facilities, the rates taking effect on |
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| July 1, 2001 shall be computed using the most recent cost | 2 |
| reports
on file with the Department of Public Aid no later than | 3 |
| April 1, 2000,
updated for inflation to January 1, 2001. For | 4 |
| rates effective July 1, 2001
only, rates shall be the greater | 5 |
| of the rate computed for July 1, 2001
or the rate effective on | 6 |
| June 30, 2001.
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| Notwithstanding any other provision of this Section, for | 8 |
| facilities
licensed by the Department of Public Health under | 9 |
| the Nursing Home Care Act
as skilled nursing facilities or | 10 |
| intermediate care facilities, the Illinois
Department shall | 11 |
| 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, | 13 |
| 2002.
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| Notwithstanding any other provision of this Section, for | 15 |
| facilities
licensed by the Department of Public Health under | 16 |
| the Nursing Home Care Act as
skilled nursing
facilities or | 17 |
| intermediate care facilities, if the payment methodologies | 18 |
| required under Section 5A-12 and the waiver granted under 42 | 19 |
| CFR 433.68 are approved by the United States Centers for | 20 |
| Medicare and Medicaid Services, the rates taking effect on July | 21 |
| 1, 2004 shall be 3.0% greater than the rates in effect on June | 22 |
| 30, 2004. These rates shall take
effect only upon approval and
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| implementation of the payment methodologies required under | 24 |
| Section 5A-12.
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| Notwithstanding any other provisions of this Section, for | 26 |
| facilities licensed by the Department of Public Health under |
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| the Nursing Home Care Act as skilled nursing facilities or | 2 |
| intermediate care facilities, the rates taking effect on | 3 |
| January 1, 2005 shall be 3% more than the rates in effect on | 4 |
| December 31, 2004.
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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, effective January 1, 2009, the | 9 |
| per diem support component of the rates effective on January 1, | 10 |
| 2008, computed using the most recent cost reports on file with | 11 |
| the Department of Healthcare and Family Services no later than | 12 |
| April 1, 2005, updated for inflation to January 1, 2006, shall | 13 |
| be increased to the amount that would have been derived using | 14 |
| standard Department of Healthcare and Family Services methods, | 15 |
| procedures, and inflators. | 16 |
| 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 intermediate care facilities that | 19 |
| are federally defined as Institutions for Mental Disease, a | 20 |
| socio-development component rate equal to 6.6% of the | 21 |
| facility's nursing component rate as of January 1, 2006 shall | 22 |
| be established and paid effective July 1, 2006. The | 23 |
| socio-development component of the rate shall be increased by a | 24 |
| factor of 2.53 on the first day of the month that begins at | 25 |
| least 45 days after January 11, 2008 (the effective date of | 26 |
| Public Act 95-707). As of August 1, 2008, the socio-development |
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| component rate shall be equal to 6.6% of the facility's nursing | 2 |
| component rate as of January 1, 2006, multiplied by a factor of | 3 |
| 3.53. The Illinois Department may by rule adjust these | 4 |
| socio-development component rates, but in no case may such | 5 |
| rates be diminished.
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| For facilities
licensed
by the
Department of Public Health | 7 |
| under the Nursing Home Care Act as Intermediate
Care for
the | 8 |
| Developmentally Disabled facilities or as long-term care | 9 |
| facilities for
residents under 22 years of age, the rates | 10 |
| taking effect on July 1,
2003 shall
include a statewide | 11 |
| increase of 4%, as defined by the Department.
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| For facilities licensed by the Department of Public Health | 13 |
| under the
Nursing Home Care Act as Intermediate Care for the | 14 |
| Developmentally Disabled
facilities or Long Term Care for Under | 15 |
| Age 22 facilities, the rates taking
effect on the first day of | 16 |
| the month that begins at least 45 days after the effective date | 17 |
| of this amendatory Act of the 95th General Assembly shall | 18 |
| include a statewide increase of 2.5%, as
defined by the | 19 |
| Department. | 20 |
| Notwithstanding any other provision of this Section, for | 21 |
| facilities licensed by the Department of Public Health under | 22 |
| the Nursing Home Care Act as skilled nursing facilities or | 23 |
| intermediate care facilities, effective January 1, 2005, | 24 |
| facility rates shall be increased by the difference between (i) | 25 |
| a facility's per diem property, liability, and malpractice | 26 |
| insurance costs as reported in the cost report filed with the |
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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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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| Rates established effective each July 1 shall govern | 7 |
| payment
for services rendered throughout that fiscal year, | 8 |
| except that rates
established on July 1, 1996 shall be | 9 |
| increased by 6.8% for services
provided on or after January 1, | 10 |
| 1997. Such rates will be based
upon the rates calculated for | 11 |
| the year beginning July 1, 1990, and for
subsequent years | 12 |
| thereafter until June 30, 2001 shall be based on the
facility | 13 |
| cost reports
for the facility fiscal year ending at any point | 14 |
| in time during the previous
calendar year, updated to the | 15 |
| midpoint of the rate year. The cost report
shall be on file | 16 |
| with the Department no later than April 1 of the current
rate | 17 |
| year. Should the cost report not be on file by April 1, the | 18 |
| Department
shall base the rate on the latest cost report filed | 19 |
| by each skilled care
facility and intermediate care facility, | 20 |
| updated to the midpoint of the
current rate year. In | 21 |
| determining rates for services rendered on and after
July 1, | 22 |
| 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 | 24 |
| would reduce
any component of the Medicaid rate to a level | 25 |
| below what that component would
have been utilizing in the rate | 26 |
| effective on July 1, 1984.
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HB0662 Engrossed |
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LRB096 04067 DRJ 14105 b |
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| (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.
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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 | 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.
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| The Department of Healthcare and Family Services
shall | 14 |
| develop precise standards for
payments to reimburse nursing | 15 |
| facilities for any utilization of
appropriate rehabilitative | 16 |
| personnel for the provision of rehabilitative
services which is | 17 |
| authorized by federal regulations, including
reimbursement for | 18 |
| services provided by qualified therapists or qualified
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| assistants, and which is in accordance with accepted | 20 |
| professional
practices. Reimbursement also may be made for | 21 |
| utilization of other
supportive personnel under appropriate | 22 |
| supervision.
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| (Source: P.A. 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; 94-697, | 24 |
| eff. 11-21-05; 94-838, eff. 6-6-06; 94-964, eff. 6-28-06; | 25 |
| 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707, eff. 1-11-08; | 26 |
| 95-744, eff. 7-18-08.)
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