Full Text of HB3635 97th General Assembly
HB3635sam001 97TH GENERAL ASSEMBLY | Sen. Don Harmon Filed: 5/19/2011
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| 1 | | AMENDMENT TO HOUSE BILL 3635
| 2 | | AMENDMENT NO. ______. Amend House Bill 3635 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Sections 5-4.2, 5-5.4, 5B-2, 5B-4, and 5B-8 as | 6 | | follows:
| 7 | | (305 ILCS 5/5-4.2) (from Ch. 23, par. 5-4.2)
| 8 | | Sec. 5-4.2. Ambulance services payments. | 9 | | (a) For
ambulance
services provided to a recipient of aid | 10 | | under this Article on or after
January 1, 1993, the Illinois | 11 | | Department shall reimburse ambulance service
providers at | 12 | | rates calculated in accordance with this Section. It is the | 13 | | intent
of the General Assembly to provide adequate | 14 | | reimbursement for ambulance
services so as to ensure adequate | 15 | | access to services for recipients of aid
under this Article and | 16 | | to provide appropriate incentives to ambulance service
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| 1 | | providers to provide services in an efficient and | 2 | | cost-effective manner. Thus,
it is the intent of the General | 3 | | Assembly that the Illinois Department implement
a | 4 | | reimbursement system for ambulance services that, to the extent | 5 | | practicable
and subject to the availability of funds | 6 | | appropriated by the General Assembly
for this purpose, is | 7 | | consistent with the payment principles of Medicare. To
ensure | 8 | | uniformity between the payment principles of Medicare and | 9 | | Medicaid, the
Illinois Department shall follow, to the extent | 10 | | necessary and practicable and
subject to the availability of | 11 | | funds appropriated by the General Assembly for
this purpose, | 12 | | the statutes, laws, regulations, policies, procedures,
| 13 | | principles, definitions, guidelines, and manuals used to | 14 | | determine the amounts
paid to ambulance service providers under | 15 | | Title XVIII of the Social Security
Act (Medicare).
| 16 | | (b) For ambulance services provided to a recipient of aid | 17 | | under this Article
on or after January 1, 1996, the Illinois | 18 | | Department shall reimburse ambulance
service providers based | 19 | | upon the actual distance traveled if a natural
disaster, | 20 | | weather conditions, road repairs, or traffic congestion | 21 | | necessitates
the use of a
route other than the most direct | 22 | | route.
| 23 | | (c) For purposes of this Section, "ambulance services" | 24 | | includes medical
transportation services provided by means of | 25 | | an ambulance, medi-car, service
car, or
taxi.
| 26 | | (c-1) For purposes of this Section, "ground ambulance |
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| 1 | | service" means medical transportation services that are | 2 | | described as ground ambulance services by the Centers for | 3 | | Medicare and Medicaid Services and provided in a vehicle that | 4 | | is licensed as an ambulance by the Illinois Department of | 5 | | Public Health pursuant to the Emergency Medical Services (EMS) | 6 | | Systems Act. | 7 | | (c-2) For purposes of this Section, "ground ambulance | 8 | | service provider" means a vehicle service provider as described | 9 | | in the Emergency Medical Services (EMS) Systems Act that | 10 | | operates licensed ambulances for the purpose of providing | 11 | | emergency ambulance services, or non-emergency ambulance | 12 | | services, or both. For purposes of this Section, this includes | 13 | | both ambulance providers and ambulance suppliers as described | 14 | | by the Centers for Medicare and Medicaid Services. | 15 | | (d) This Section does not prohibit separate billing by | 16 | | ambulance service
providers for oxygen furnished while | 17 | | providing advanced life support
services.
| 18 | | (e) Beginning with services rendered on or after July 1, | 19 | | 2008, all providers of non-emergency medi-car and service car | 20 | | transportation must certify that the driver and employee | 21 | | attendant, as applicable, have completed a safety program | 22 | | approved by the Department to protect both the patient and the | 23 | | driver, prior to transporting a patient.
The provider must | 24 | | maintain this certification in its records. The provider shall | 25 | | produce such documentation upon demand by the Department or its | 26 | | representative. Failure to produce documentation of such |
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| 1 | | training shall result in recovery of any payments made by the | 2 | | Department for services rendered by a non-certified driver or | 3 | | employee attendant. Medi-car and service car providers must | 4 | | maintain legible documentation in their records of the driver | 5 | | and, as applicable, employee attendant that actually | 6 | | transported the patient. Providers must recertify all drivers | 7 | | and employee attendants every 3 years.
| 8 | | Notwithstanding the requirements above, any public | 9 | | transportation provider of medi-car and service car | 10 | | transportation that receives federal funding under 49 U.S.C. | 11 | | 5307 and 5311 need not certify its drivers and employee | 12 | | attendants under this Section, since safety training is already | 13 | | federally mandated.
| 14 | | (f) With respect to any policy or program administered by | 15 | | the Department or its agent regarding approval of non-emergency | 16 | | medical transportation by ground ambulance service providers, | 17 | | including, but not limited to, the Non-Emergency | 18 | | Transportation Services Prior Approval Program (NETSPAP), the | 19 | | Department shall establish by rule a process by which ground | 20 | | ambulance service providers of non-emergency medical | 21 | | transportation may appeal any decision by the Department or its | 22 | | agent for which no denial was received prior to the time of | 23 | | transport that either (i) denies a request for approval for | 24 | | payment of non-emergency transportation by means of ground | 25 | | ambulance service or (ii) grants a request for approval of | 26 | | non-emergency transportation by means of ground ambulance |
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| 1 | | service at a level of service that entitles the ground | 2 | | ambulance service provider to a lower level of compensation | 3 | | from the Department than the ground ambulance service provider | 4 | | would have received as compensation for the level of service | 5 | | requested. The rule shall be established within 12 months after | 6 | | the effective date of this amendatory Act of the 97th General | 7 | | Assembly and shall provide that, for any decision rendered by | 8 | | the Department or its agent on or after the date the rule takes | 9 | | effect, the ground ambulance service provider shall have 60 | 10 | | days from the date the decision is received to file an appeal. | 11 | | The rule established by the Department shall be, insofar as is | 12 | | practical, consistent with the Illinois Administrative | 13 | | Procedure Act. The Director's decision on an appeal under this | 14 | | Section shall be a final administrative decision subject to | 15 | | review under the Administrative Review Law. | 16 | | (Source: P.A. 95-501, eff. 8-28-07.)
| 17 | | (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4) | 18 | | Sec. 5-5.4. Standards of Payment - Department of Healthcare | 19 | | and Family Services.
The Department of Healthcare and Family | 20 | | Services shall develop standards of payment of
nursing facility | 21 | | and ICF/DD services in facilities providing such services
under | 22 | | this Article which:
| 23 | | (1) Provide for the determination of a facility's payment
| 24 | | for nursing facility or ICF/DD services on a prospective basis.
| 25 | | The amount of the payment rate for all nursing facilities |
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| 1 | | certified by the
Department of Public Health under the MR/DD | 2 | | Community Care Act or the Nursing Home Care Act as Intermediate
| 3 | | Care for the Developmentally Disabled facilities, Long Term | 4 | | Care for Under Age
22 facilities, Skilled Nursing facilities, | 5 | | or Intermediate Care facilities
under the
medical assistance | 6 | | program shall be prospectively established annually on the
| 7 | | basis of historical, financial, and statistical data | 8 | | reflecting actual costs
from prior years, which shall be | 9 | | applied to the current rate year and updated
for inflation, | 10 | | except that the capital cost element for newly constructed
| 11 | | facilities shall be based upon projected budgets. The annually | 12 | | established
payment rate shall take effect on July 1 in 1984 | 13 | | and subsequent years. No rate
increase and no
update for | 14 | | inflation shall be provided on or after July 1, 1994 and before
| 15 | | July 1, 2012, unless specifically provided for in this
Section.
| 16 | | The changes made by Public Act 93-841
extending the duration of | 17 | | the prohibition against a rate increase or update for inflation | 18 | | are effective retroactive to July 1, 2004.
| 19 | | For facilities licensed by the Department of Public Health | 20 | | under the Nursing
Home Care Act as Intermediate Care for the | 21 | | Developmentally Disabled facilities
or Long Term Care for Under | 22 | | Age 22 facilities, the rates taking effect on July
1, 1998 | 23 | | shall include an increase of 3%. For facilities licensed by the
| 24 | | 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,
1998 shall include an |
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| 1 | | increase of 3% plus $1.10 per resident-day, as defined by
the | 2 | | Department. For facilities licensed by the Department of Public | 3 | | Health under the Nursing Home Care Act as Intermediate Care | 4 | | Facilities for the Developmentally Disabled or Long Term Care | 5 | | for Under Age 22 facilities, the rates taking effect on January | 6 | | 1, 2006 shall include an increase of 3%.
For facilities | 7 | | licensed by the Department of Public Health under the Nursing | 8 | | Home Care Act as Intermediate Care Facilities for the | 9 | | Developmentally Disabled or Long Term Care for Under Age 22 | 10 | | facilities, the rates taking effect on January 1, 2009 shall | 11 | | include an increase sufficient to provide a $0.50 per hour wage | 12 | | increase for non-executive staff. | 13 | | For facilities licensed by the Department of Public Health | 14 | | under the
Nursing Home Care Act as Intermediate Care for the | 15 | | Developmentally Disabled
facilities or Long Term Care for Under | 16 | | Age 22 facilities, the rates taking
effect on July 1, 1999 | 17 | | shall include an increase of 1.6% plus $3.00 per
resident-day, | 18 | | as defined by the Department. For facilities licensed by the
| 19 | | Department of Public Health under the Nursing Home Care Act as | 20 | | Skilled Nursing
facilities or Intermediate Care facilities, | 21 | | the rates taking effect on July 1,
1999 shall include an | 22 | | increase of 1.6% and, for services provided on or after
October | 23 | | 1, 1999, shall be increased by $4.00 per resident-day, as | 24 | | defined by
the Department.
| 25 | | For facilities licensed by the Department of Public Health | 26 | | under the
Nursing Home Care Act as Intermediate Care for the |
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| 1 | | Developmentally Disabled
facilities or Long Term Care for Under | 2 | | Age 22 facilities, the rates taking
effect on July 1, 2000 | 3 | | shall include an increase of 2.5% per resident-day,
as defined | 4 | | by the Department. For facilities licensed by the Department of
| 5 | | Public Health under the Nursing Home Care Act as Skilled | 6 | | Nursing facilities or
Intermediate Care facilities, the rates | 7 | | taking effect on July 1, 2000 shall
include an increase of 2.5% | 8 | | per resident-day, as defined by the Department.
| 9 | | For facilities licensed by the Department of Public Health | 10 | | under the
Nursing Home Care Act as skilled nursing facilities | 11 | | or intermediate care
facilities, a new payment methodology must | 12 | | be implemented for the nursing
component of the rate effective | 13 | | July 1, 2003. The Department of Public Aid
(now Healthcare and | 14 | | Family Services) shall develop the new payment methodology | 15 | | using the Minimum Data Set
(MDS) as the instrument to collect | 16 | | information concerning nursing home
resident condition | 17 | | necessary to compute the rate. The Department
shall develop the | 18 | | new payment methodology to meet the unique needs of
Illinois | 19 | | nursing home residents while remaining subject to the | 20 | | appropriations
provided by the General Assembly.
A transition | 21 | | period from the payment methodology in effect on June 30, 2003
| 22 | | to the payment methodology in effect on July 1, 2003 shall be | 23 | | provided for a
period not exceeding 3 years and 184 days after | 24 | | implementation of the new payment
methodology as follows:
| 25 | | (A) For a facility that would receive a lower
nursing | 26 | | component rate per patient day under the new system than |
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| 1 | | the facility
received
effective on the date immediately | 2 | | preceding the date that the Department
implements the new | 3 | | payment methodology, the nursing component rate per | 4 | | patient
day for the facility
shall be held at
the level in | 5 | | effect on the date immediately preceding the date that the
| 6 | | Department implements the new payment methodology until a | 7 | | higher nursing
component rate of
reimbursement is achieved | 8 | | by that
facility.
| 9 | | (B) For a facility that would receive a higher nursing | 10 | | component rate per
patient day under the payment | 11 | | methodology in effect on July 1, 2003 than the
facility | 12 | | received effective on the date immediately preceding the | 13 | | date that the
Department implements the new payment | 14 | | methodology, the nursing component rate
per patient day for | 15 | | the facility shall be adjusted.
| 16 | | (C) Notwithstanding paragraphs (A) and (B), the | 17 | | nursing component rate per
patient day for the facility | 18 | | shall be adjusted subject to appropriations
provided by the | 19 | | General Assembly.
| 20 | | For facilities licensed by the Department of Public Health | 21 | | under the
Nursing Home Care Act as Intermediate Care for the | 22 | | Developmentally Disabled
facilities or Long Term Care for Under | 23 | | Age 22 facilities, the rates taking
effect on March 1, 2001 | 24 | | shall include a statewide increase of 7.85%, as
defined by the | 25 | | Department.
| 26 | | Notwithstanding any other provision of this Section, for |
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| 1 | | facilities licensed by the Department of Public Health under | 2 | | the
Nursing Home Care Act as skilled nursing facilities or | 3 | | intermediate care
facilities, except facilities participating | 4 | | in the Department's demonstration program pursuant to the | 5 | | provisions of Title 77, Part 300, Subpart T of the Illinois | 6 | | Administrative Code, the numerator of the ratio used by the | 7 | | Department of Healthcare and Family Services to compute the | 8 | | rate payable under this Section using the Minimum Data Set | 9 | | (MDS) methodology shall incorporate the following annual | 10 | | amounts as the additional funds appropriated to the Department | 11 | | specifically to pay for rates based on the MDS nursing | 12 | | component methodology in excess of the funding in effect on | 13 | | December 31, 2006: | 14 | | (i) For rates taking effect January 1, 2007, | 15 | | $60,000,000. | 16 | | (ii) For rates taking effect January 1, 2008, | 17 | | $110,000,000. | 18 | | (iii) For rates taking effect January 1, 2009, | 19 | | $194,000,000. | 20 | | (iv) For rates taking effect April 1, 2011, or the | 21 | | first day of the month that begins at least 45 days after | 22 | | the effective date of this amendatory Act of the 96th | 23 | | General Assembly, $416,500,000 or an amount as may be | 24 | | necessary to complete the transition to the MDS methodology | 25 | | for the nursing component of the rate. Increased payments | 26 | | under this item (iv) are not due and payable, however, |
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| 1 | | until (i) the methodologies described in this paragraph are | 2 | | approved by the federal government in an appropriate State | 3 | | Plan amendment and (ii) the assessment imposed by Section | 4 | | 5B-2 of this Code is determined to be a permissible tax | 5 | | under Title XIX of the Social Security Act. | 6 | | 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 skilled nursing facilities or | 9 | | intermediate care facilities, the support component of the | 10 | | rates taking effect on January 1, 2008 shall be computed using | 11 | | the most recent cost reports on file with the Department of | 12 | | Healthcare and Family Services no later than April 1, 2005, | 13 | | updated for inflation to January 1, 2006. | 14 | | For facilities licensed by the Department of Public Health | 15 | | under the
Nursing Home Care Act as Intermediate Care for the | 16 | | Developmentally Disabled
facilities or Long Term Care for Under | 17 | | Age 22 facilities, the rates taking
effect on April 1, 2002 | 18 | | shall include a statewide increase of 2.0%, as
defined by the | 19 | | Department.
This increase terminates on July 1, 2002;
beginning | 20 | | July 1, 2002 these rates are reduced to the level of the rates
| 21 | | in effect on March 31, 2002, as defined by the Department.
| 22 | | For facilities licensed by the Department of Public Health | 23 | | under the
Nursing Home Care Act as skilled nursing facilities | 24 | | or intermediate care
facilities, the rates taking effect on | 25 | | July 1, 2001 shall be computed using the most recent cost | 26 | | reports
on file with the Department of Public Aid no later than |
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| 1 | | April 1, 2000,
updated for inflation to January 1, 2001. For | 2 | | rates effective July 1, 2001
only, rates shall be the greater | 3 | | of the rate computed for July 1, 2001
or the rate effective on | 4 | | June 30, 2001.
| 5 | | 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, the Illinois
Department shall | 9 | | determine by rule the rates taking effect on July 1, 2002,
| 10 | | which shall be 5.9% less than the rates in effect on June 30, | 11 | | 2002.
| 12 | | Notwithstanding any other provision of this Section, for | 13 | | facilities
licensed by the Department of Public Health under | 14 | | the Nursing Home Care Act as
skilled nursing
facilities or | 15 | | intermediate care facilities, if the payment methodologies | 16 | | required under Section 5A-12 and the waiver granted under 42 | 17 | | CFR 433.68 are approved by the United States Centers for | 18 | | Medicare and Medicaid Services, the rates taking effect on July | 19 | | 1, 2004 shall be 3.0% greater than the rates in effect on June | 20 | | 30, 2004. These rates shall take
effect only upon approval and
| 21 | | implementation of the payment methodologies required under | 22 | | Section 5A-12.
| 23 | | Notwithstanding any other provisions of this Section, for | 24 | | facilities licensed by the Department of Public Health under | 25 | | the Nursing Home Care Act as skilled nursing facilities or | 26 | | intermediate care facilities, the rates taking effect on |
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| 1 | | January 1, 2005 shall be 3% more than the rates in effect on | 2 | | December 31, 2004.
| 3 | | Notwithstanding any other provision of this Section, for | 4 | | facilities licensed by the Department of Public Health under | 5 | | the Nursing Home Care Act as skilled nursing facilities or | 6 | | intermediate care facilities, effective January 1, 2009, the | 7 | | per diem support component of the rates effective on January 1, | 8 | | 2008, computed using the most recent cost reports on file with | 9 | | the Department of Healthcare and Family Services no later than | 10 | | April 1, 2005, updated for inflation to January 1, 2006, shall | 11 | | be increased to the amount that would have been derived using | 12 | | standard Department of Healthcare and Family Services methods, | 13 | | procedures, and inflators. | 14 | | Notwithstanding any other provisions of this Section, for | 15 | | facilities licensed by the Department of Public Health under | 16 | | the Nursing Home Care Act as intermediate care facilities that | 17 | | are federally defined as Institutions for Mental Disease, a | 18 | | socio-development component rate equal to 6.6% of the | 19 | | facility's nursing component rate as of January 1, 2006 shall | 20 | | be established and paid effective July 1, 2006. The | 21 | | socio-development component of the rate shall be increased by a | 22 | | factor of 2.53 on the first day of the month that begins at | 23 | | least 45 days after January 11, 2008 (the effective date of | 24 | | Public Act 95-707). As of August 1, 2008, the socio-development | 25 | | component rate shall be equal to 6.6% of the facility's nursing | 26 | | component rate as of January 1, 2006, multiplied by a factor of |
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| 1 | | 3.53. For services provided on or after April 1, 2011, or the | 2 | | first day of the month that begins at least 45 days after the | 3 | | effective date of this amendatory Act of the 96th General | 4 | | Assembly, whichever is later, the Illinois Department may by | 5 | | rule adjust these socio-development component rates, and may | 6 | | use different adjustment methodologies for those facilities | 7 | | participating, and those not participating, in the Illinois | 8 | | Department's demonstration program pursuant to the provisions | 9 | | of Title 77, Part 300, Subpart T of the Illinois Administrative | 10 | | Code, but in no case may such rates be diminished below those | 11 | | in effect on August 1, 2008.
| 12 | | 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 as long-term care | 15 | | facilities for
residents under 22 years of age, the rates | 16 | | taking effect on July 1,
2003 shall
include a statewide | 17 | | increase of 4%, as defined by the Department.
| 18 | | 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 the first day of | 22 | | the month that begins at least 45 days after the effective date | 23 | | of this amendatory Act of the 95th General Assembly shall | 24 | | include a statewide increase of 2.5%, as
defined by the | 25 | | Department. | 26 | | Notwithstanding any other provision of this Section, for |
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| 1 | | facilities licensed by the Department of Public Health under | 2 | | the Nursing Home Care Act as skilled nursing facilities or | 3 | | intermediate care facilities, effective January 1, 2005, | 4 | | facility rates shall be increased by the difference between (i) | 5 | | a facility's per diem property, liability, and malpractice | 6 | | insurance costs as reported in the cost report filed with the | 7 | | Department of Public Aid and used to establish rates effective | 8 | | July 1, 2001 and (ii) those same costs as reported in the | 9 | | facility's 2002 cost report. These costs shall be passed | 10 | | through to the facility without caps or limitations, except for | 11 | | adjustments required under normal auditing procedures.
| 12 | | Rates established effective each July 1 shall govern | 13 | | payment
for services rendered throughout that fiscal year, | 14 | | except that rates
established on July 1, 1996 shall be | 15 | | increased by 6.8% for services
provided on or after January 1, | 16 | | 1997. Such rates will be based
upon the rates calculated for | 17 | | the year beginning July 1, 1990, and for
subsequent years | 18 | | thereafter until June 30, 2001 shall be based on the
facility | 19 | | cost reports
for the facility fiscal year ending at any point | 20 | | in time during the previous
calendar year, updated to the | 21 | | midpoint of the rate year. The cost report
shall be on file | 22 | | with the Department no later than April 1 of the current
rate | 23 | | year. Should the cost report not be on file by April 1, the | 24 | | Department
shall base the rate on the latest cost report filed | 25 | | by each skilled care
facility and intermediate care facility, | 26 | | updated to the midpoint of the
current rate year. In |
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| 1 | | determining rates for services rendered on and after
July 1, | 2 | | 1985, fixed time shall not be computed at less than zero. The
| 3 | | Department shall not make any alterations of regulations which | 4 | | would reduce
any component of the Medicaid rate to a level | 5 | | below what that component would
have been utilizing in the rate | 6 | | effective on July 1, 1984.
| 7 | | (2) Shall take into account the actual costs incurred by | 8 | | facilities
in providing services for recipients of skilled | 9 | | nursing and intermediate
care services under the medical | 10 | | assistance program.
| 11 | | (3) Shall take into account the medical and psycho-social
| 12 | | characteristics and needs of the patients.
| 13 | | (4) Shall take into account the actual costs incurred by | 14 | | facilities in
meeting licensing and certification standards | 15 | | imposed and prescribed by the
State of Illinois, any of its | 16 | | political subdivisions or municipalities and by
the U.S. | 17 | | Department of Health and Human Services pursuant to Title XIX | 18 | | of the
Social Security Act.
| 19 | | The Department of Healthcare and Family Services
shall | 20 | | develop precise standards for
payments to reimburse nursing | 21 | | facilities for any utilization of
appropriate rehabilitative | 22 | | personnel for the provision of rehabilitative
services which is | 23 | | authorized by federal regulations, including
reimbursement for | 24 | | services provided by qualified therapists or qualified
| 25 | | assistants, and which is in accordance with accepted | 26 | | professional
practices. Reimbursement also may be made for |
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| 1 | | utilization of other
supportive personnel under appropriate | 2 | | supervision.
| 3 | | The Department shall develop enhanced payments to offset | 4 | | the additional costs incurred by a
facility serving exceptional | 5 | | need residents and shall allocate at least $8,000,000 of the | 6 | | funds
collected from the assessment established by Section 5B-2 | 7 | | of this Code for such payments. For
the purpose of this | 8 | | Section, "exceptional needs" means, but need not be limited to, | 9 | | ventilator care, tracheotomy care,
bariatric care, complex | 10 | | wound care, and traumatic brain injury care. The enhanced | 11 | | payments for exceptional need residents under this paragraph | 12 | | are not due and payable, however, until (i) the methodologies | 13 | | described in this paragraph are approved by the federal | 14 | | government in an appropriate State Plan amendment and (ii) the | 15 | | assessment imposed by Section 5B-2 of this Code is determined | 16 | | to be a permissible tax under Title XIX of the Social Security | 17 | | Act. | 18 | | (5) Beginning July 1, 2012 the methodologies for | 19 | | reimbursement of nursing facility services as provided under | 20 | | this Section 5-5.4 shall no longer be applicable for bills | 21 | | payable for State fiscal years 2012 and thereafter. | 22 | | (6) No payment increase under this Section for the MDS | 23 | | methodology, exceptional care residents, or the | 24 | | socio-development component rate established by Public Act | 25 | | 96-1530 of the 96th General Assembly and funded by the | 26 | | assessment imposed under Section 5B-2 of this Code shall be due |
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| 1 | | and payable until after the Department notifies the long-term | 2 | | care providers, in writing, that the payment methodologies to | 3 | | long-term care providers required under this Section have been | 4 | | approved by the Centers for Medicare and Medicaid Services of | 5 | | the U.S. Department of Health and Human Services and the | 6 | | waivers under 42 CFR 433.68 for the assessment imposed by this | 7 | | Section, if necessary, have been granted by the Centers for | 8 | | Medicare and Medicaid Services of the U.S. Department of Health | 9 | | and Human Services. Upon notification to the Department of | 10 | | approval of the payment methodologies required under this | 11 | | Section and the waivers granted under 42 CFR 433.68, all | 12 | | increased payments otherwise due under this Section prior to | 13 | | the date of notification shall be due and payable within 90 | 14 | | days of the date federal approval is received. | 15 | | (Source: P.A. 95-12, eff. 7-2-07; 95-331, eff. 8-21-07; 95-707, | 16 | | eff. 1-11-08; 95-744, eff. 7-18-08; 96-45, eff. 7-15-09; | 17 | | 96-339, eff. 7-1-10; 96-959, eff. 7-1-10; 96-1000, eff. 7-2-10; | 18 | | 96-1530, eff. 2-16-11.)
| 19 | | (305 ILCS 5/5B-2) (from Ch. 23, par. 5B-2)
| 20 | | Sec. 5B-2. Assessment; no local authorization to tax.
| 21 | | (a) For the privilege of engaging in the occupation of | 22 | | long-term care
provider, beginning July 1, 2011 an assessment | 23 | | is imposed upon each long-term care provider in an amount equal | 24 | | to $6.07 times the number of occupied bed days due and payable | 25 | | each month. Notwithstanding any provision of any other Act to |
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| 1 | | the
contrary, this assessment shall be construed as a tax, but | 2 | | shall not be billed or passed on to any resident of a nursing | 3 | | home operated by the nursing home provider may not be added
to | 4 | | the charges of an individual's nursing home care that is paid | 5 | | for in
whole, or in part, by a federal, State, or combined | 6 | | federal-state medical
care program .
| 7 | | (b) Nothing in this amendatory Act of 1992 shall be | 8 | | construed to
authorize any home rule unit or other unit of | 9 | | local government to license
for revenue or impose a tax or | 10 | | assessment upon long-term care providers or
the occupation of | 11 | | long-term care provider, or a tax or assessment measured
by the | 12 | | income or earnings or occupied bed days of a long-term care | 13 | | provider.
| 14 | | (c) The assessment imposed by this Section shall not be due | 15 | | and payable, however, until after the Department notifies the | 16 | | long-term care providers, in writing, that the payment | 17 | | methodologies to long-term care providers required under | 18 | | Section 5-5.4 of this Code have been approved by the Centers | 19 | | for Medicare and Medicaid Services of the U.S. Department of | 20 | | Health and Human Services and the waivers under 42 CFR 433.68 | 21 | | for the assessment imposed by this Section, if necessary, have | 22 | | been granted by the Centers for Medicare and Medicaid Services | 23 | | of the U.S. Department of Health and Human Services. | 24 | | (Source: P.A. 96-1530, eff. 2-16-11.)
| 25 | | (305 ILCS 5/5B-4) (from Ch. 23, par. 5B-4)
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| 1 | | Sec. 5B-4. Payment of assessment; penalty.
| 2 | | (a) The assessment imposed by Section 5B-2 shall be due and | 3 | | payable monthly, on the last State business day of the month | 4 | | for occupied bed days reported for the preceding third month | 5 | | prior to the month in which the tax is payable and due. A | 6 | | facility that has delayed payment due to the State's failure to | 7 | | reimburse for services rendered may request an extension on the | 8 | | due date for payment pursuant to subsection (b) and shall pay | 9 | | the assessment within 30 days of reimbursement by the | 10 | | Department.
The Illinois Department may provide that county | 11 | | nursing homes directed and
maintained pursuant to Section | 12 | | 5-1005 of the Counties Code may meet their
assessment | 13 | | obligation by certifying to the Illinois Department that county
| 14 | | expenditures have been obligated for the operation of the | 15 | | county nursing
home in an amount at least equal to the amount | 16 | | of the assessment.
| 17 | | (a-5) Each assessment payment shall be accompanied by an | 18 | | assessment report to be completed by the long-term care | 19 | | provider. A separate report shall be completed for each | 20 | | long-term care facility in this State operated by a long-term | 21 | | care provider. The report shall be in a form and manner | 22 | | prescribed by the Illinois Department and shall at a minimum | 23 | | provide for the reporting of the number of occupied bed days of | 24 | | the long-term care facility for the reporting period and other | 25 | | reasonable information the Illinois Department requires for | 26 | | the administration of its responsibilities under this Code. To |
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| 1 | | the extent practicable, the Department shall coordinate the | 2 | | assessment reporting requirements with other reporting | 3 | | required of long-term care facilities. | 4 | | (b) The Illinois Department is authorized to establish
| 5 | | delayed payment schedules for long-term care providers that are
| 6 | | unable to make assessment payments when due under this Section
| 7 | | due to financial difficulties, as determined by the Illinois
| 8 | | Department. The Illinois Department may not deny a request for | 9 | | delay of payment of the assessment imposed under this Article | 10 | | if the long-term care provider has not been paid for services | 11 | | provided during the month on which the assessment is levied.
| 12 | | (c) If a long-term care provider fails to pay the full
| 13 | | amount of an assessment payment when due (including any | 14 | | extensions
granted under subsection (b)), there shall, unless | 15 | | waived by the
Illinois Department for reasonable cause, be | 16 | | added to the
assessment imposed by Section 5B-2 a
penalty | 17 | | assessment equal to the lesser of (i) 5% of the amount of
the | 18 | | assessment payment not paid on or before the due date plus 5% | 19 | | of the
portion thereof remaining unpaid on the last day of each | 20 | | month
thereafter or (ii) 100% of the assessment payment amount | 21 | | not paid on or
before the due date. For purposes of this | 22 | | subsection, payments
will be credited first to unpaid | 23 | | assessment payment amounts (rather than
to penalty or | 24 | | interest), beginning with the most delinquent assessment | 25 | | payments. Payment cycles of longer than 60 days shall be one | 26 | | factor the Director takes into account in granting a waiver |
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| 1 | | under this Section.
| 2 | | (c-5) If a long-term care provider fails to file its report | 3 | | with payment, there shall, unless waived by the Illinois | 4 | | Department for reasonable cause, be added to the assessment due | 5 | | a penalty assessment equal to 25% of the assessment due. | 6 | | (d) Nothing in this amendatory Act of 1993 shall be | 7 | | construed to prevent
the Illinois Department from collecting | 8 | | all amounts due under this Article
pursuant to an assessment | 9 | | imposed before the effective date of this amendatory
Act of | 10 | | 1993.
| 11 | | (e) Nothing in this amendatory Act of the 96th General | 12 | | Assembly shall be construed to prevent
the Illinois Department | 13 | | from collecting all amounts due under this Code
pursuant to an | 14 | | assessment, tax, fee, or penalty imposed before the effective | 15 | | date of this amendatory
Act of the 96th General Assembly. | 16 | | (f) No installment of the assessment imposed by Section | 17 | | 5B-2 shall be due and payable until after the Department | 18 | | notifies the long-term care providers, in writing, that the | 19 | | payment methodologies to long-term care providers required | 20 | | under Section 5-5.4 of this Code have been approved by the | 21 | | Centers for Medicare and Medicaid Services of the U.S. | 22 | | Department of Health and Human Services and the waivers under | 23 | | 42 CFR 433.68 for the assessment imposed by this Section, if | 24 | | necessary, have been granted by the Centers for Medicare and | 25 | | Medicaid Services of the U.S. Department of Health and Human | 26 | | Services. Upon notification to the Department of approval of |
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| 1 | | the payment methodologies required under Section 5-5.4 of this | 2 | | Code and the waivers granted under 42 CFR 433.68, all | 3 | | installments otherwise due under Section 5B-4 prior to the date | 4 | | of notification shall be due and payable to the Department upon | 5 | | written direction from the Department within 90 days after | 6 | | issuance by the Comptroller of the payments required under | 7 | | Section 5-5.4 of this Code. | 8 | | (Source: P.A. 96-444, eff. 8-14-09; 96-1530, eff. 2-16-11.)
| 9 | | (305 ILCS 5/5B-8) (from Ch. 23, par. 5B-8)
| 10 | | Sec. 5B-8. Long-Term Care Provider Fund.
| 11 | | (a) There is created in the State Treasury the Long-Term
| 12 | | Care Provider Fund. Interest earned by the Fund shall be
| 13 | | credited to the Fund. The Fund shall not be used to replace any
| 14 | | moneys appropriated to the Medicaid program by the General | 15 | | Assembly.
| 16 | | (b) The Fund is created for the purpose of receiving and
| 17 | | disbursing moneys in accordance with this Article. | 18 | | Disbursements
from the Fund shall be made only as follows:
| 19 | | (1) For payments to nursing
facilities, including | 20 | | county nursing facilities but excluding
State-operated | 21 | | facilities, under Title XIX of the Social Security
Act and | 22 | | Article V of this Code.
| 23 | | (2) For the reimbursement of moneys collected by the
| 24 | | Illinois Department through error or mistake.
| 25 | | (3) For payment of administrative expenses incurred by |
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| 1 | | the
Illinois Department or its agent in performing the | 2 | | activities
authorized by this Article.
| 3 | | (3.5) For reimbursement of expenses incurred by | 4 | | long-term care facilities, and payment of administrative | 5 | | expenses incurred by the Department of Public Health, in | 6 | | relation to the conduct and analysis of background checks | 7 | | for identified offenders under the Nursing Home Care Act.
| 8 | | (4) For payments of any amounts that are reimbursable | 9 | | to the
federal government for payments from this Fund that | 10 | | are required
to be paid by State warrant.
| 11 | | (5) For making transfers to the General Obligation Bond
| 12 | | Retirement and Interest Fund, as those transfers are | 13 | | authorized
in the proceedings authorizing debt under the | 14 | | Short Term Borrowing Act,
but transfers made under this | 15 | | paragraph (5) shall not exceed the
principal amount of debt | 16 | | issued in anticipation of the receipt by
the State of | 17 | | moneys to be deposited into the Fund.
| 18 | | (6) For making transfers, at the direction of the | 19 | | Director of the Governor's Office of Management and Budget | 20 | | during each fiscal year beginning on or after July 1, 2011, | 21 | | to other State funds in an annual amount of $20,000,000 of | 22 | | the tax collected pursuant to this Article for the purpose | 23 | | of enforcement of nursing home standards, support of the | 24 | | ombudsman program, and efforts to expand home and | 25 | | community-based services. No transfer under this paragraph | 26 | | shall occur until (i) the payment methodologies created by |
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| 1 | | Public Act 96-1530 under Section 5-5.4 of this Code have | 2 | | been approved by the Centers for Medicare and Medicaid | 3 | | Services of the U.S. Department of Health and Human | 4 | | Services and (ii) the assessment imposed by Section 5B-2 of | 5 | | this Code is determined to be a permissible tax under Title | 6 | | XIX of the Social Security Act. | 7 | | Disbursements from the Fund, other than transfers made | 8 | | pursuant to paragraphs (5) and (6) of this subsection, shall be | 9 | | by
warrants drawn by the State Comptroller upon receipt of | 10 | | vouchers
duly executed and certified by the Illinois | 11 | | Department.
| 12 | | (c) The Fund shall consist of the following:
| 13 | | (1) All moneys collected or received by the Illinois
| 14 | | Department from the long-term care provider assessment | 15 | | imposed by
this Article.
| 16 | | (2) All federal matching funds received by the Illinois
| 17 | | Department as a result of expenditures made by the Illinois
| 18 | | Department that are attributable to moneys deposited in the | 19 | | Fund.
| 20 | | (3) Any interest or penalty levied in conjunction with | 21 | | the
administration of this Article.
| 22 | | (4) (Blank).
| 23 | | (5) All other monies received for the Fund from any | 24 | | other source,
including interest earned thereon.
| 25 | | (Source: P.A. 95-707, eff. 1-11-08; 96-1530, eff. 2-16-11.)
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| 1 | | Section 99. Effective date. This Act takes effect upon | 2 | | becoming law.".
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