Full Text of SB3526 101st General Assembly
SB3526 101ST GENERAL ASSEMBLY |
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020 SB3526 Introduced 2/14/2020, by Sen. Sara Feigenholtz SYNOPSIS AS INTRODUCED: |
| 305 ILCS 5/5-5.2 | from Ch. 23, par. 5-5.2 |
|
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that, in applying the regional wage adjuster component of the RUG-IV 48 reimbursement methodology, no adjuster shall be lower than 0.95. Effective immediately.
|
| |
| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
|
| | | SB3526 | | LRB101 17781 KTG 67209 b |
|
| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 5-5.2 as follows:
| 6 | | (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
| 7 | | Sec. 5-5.2. Payment.
| 8 | | (a) All nursing facilities that are grouped pursuant to | 9 | | Section
5-5.1 of this Act shall receive the same rate of | 10 | | payment for similar
services.
| 11 | | (b) It shall be a matter of State policy that the Illinois | 12 | | Department
shall utilize a uniform billing cycle throughout the | 13 | | State for the
long-term care providers.
| 14 | | (c) Notwithstanding any other provisions of this Code, the | 15 | | methodologies for reimbursement of nursing services as | 16 | | provided under this Article shall no longer be applicable for | 17 | | bills payable for nursing services rendered on or after a new | 18 | | reimbursement system based on the Resource Utilization Groups | 19 | | (RUGs) has been fully operationalized, which shall take effect | 20 | | for services provided on or after January 1, 2014. | 21 | | (d) The new nursing services reimbursement methodology | 22 | | utilizing RUG-IV 48 grouper model, which shall be referred to | 23 | | as the RUGs reimbursement system, taking effect January 1, |
| | | SB3526 | - 2 - | LRB101 17781 KTG 67209 b |
|
| 1 | | 2014, shall be based on the following: | 2 | | (1) The methodology shall be resident-driven, | 3 | | facility-specific, and cost-based. | 4 | | (2) Costs shall be annually rebased and case mix index | 5 | | quarterly updated. The nursing services methodology will | 6 | | be assigned to the Medicaid enrolled residents on record as | 7 | | of 30 days prior to the beginning of the rate period in the | 8 | | Department's Medicaid Management Information System (MMIS) | 9 | | as present on the last day of the second quarter preceding | 10 | | the rate period based upon the Assessment Reference Date of | 11 | | the Minimum Data Set (MDS). | 12 | | (3) Regional wage adjustors based on the Health Service | 13 | | Areas (HSA) groupings and adjusters in effect on April 30, | 14 | | 2012 shall be included , except no adjuster shall be lower | 15 | | than 0.95 . | 16 | | (4) Case mix index shall be assigned to each resident | 17 | | class based on the Centers for Medicare and Medicaid | 18 | | Services staff time measurement study in effect on July 1, | 19 | | 2013, utilizing an index maximization approach. | 20 | | (5) The pool of funds available for distribution by | 21 | | case mix and the base facility rate shall be determined | 22 | | using the formula contained in subsection (d-1). | 23 | | (d-1) Calculation of base year Statewide RUG-IV nursing | 24 | | base per diem rate. | 25 | | (1) Base rate spending pool shall be: | 26 | | (A) The base year resident days which are |
| | | SB3526 | - 3 - | LRB101 17781 KTG 67209 b |
|
| 1 | | calculated by multiplying the number of Medicaid | 2 | | residents in each nursing home as indicated in the MDS | 3 | | data defined in paragraph (4) by 365. | 4 | | (B) Each facility's nursing component per diem in | 5 | | effect on July 1, 2012 shall be multiplied by | 6 | | subsection (A). | 7 | | (C) Thirteen million is added to the product of | 8 | | subparagraph (A) and subparagraph (B) to adjust for the | 9 | | exclusion of nursing homes defined in paragraph (5). | 10 | | (2) For each nursing home with Medicaid residents as | 11 | | indicated by the MDS data defined in paragraph (4), | 12 | | weighted days adjusted for case mix and regional wage | 13 | | adjustment shall be calculated. For each home this | 14 | | calculation is the product of: | 15 | | (A) Base year resident days as calculated in | 16 | | subparagraph (A) of paragraph (1). | 17 | | (B) The nursing home's regional wage adjustor | 18 | | based on the Health Service Areas (HSA) groupings and | 19 | | adjustors in effect on April 30, 2012. | 20 | | (C) Facility weighted case mix which is the number | 21 | | of Medicaid residents as indicated by the MDS data | 22 | | defined in paragraph (4) multiplied by the associated | 23 | | case weight for the RUG-IV 48 grouper model using | 24 | | standard RUG-IV procedures for index maximization. | 25 | | (D) The sum of the products calculated for each | 26 | | nursing home in subparagraphs (A) through (C) above |
| | | SB3526 | - 4 - | LRB101 17781 KTG 67209 b |
|
| 1 | | shall be the base year case mix, rate adjusted weighted | 2 | | days. | 3 | | (3) The Statewide RUG-IV nursing base per diem rate: | 4 | | (A) on January 1, 2014 shall be the quotient of the | 5 | | paragraph (1) divided by the sum calculated under | 6 | | subparagraph (D) of paragraph (2); and | 7 | | (B) on and after July 1, 2014, shall be the amount | 8 | | calculated under subparagraph (A) of this paragraph | 9 | | (3) plus $1.76. | 10 | | (4) Minimum Data Set (MDS) comprehensive assessments | 11 | | for Medicaid residents on the last day of the quarter used | 12 | | to establish the base rate. | 13 | | (5) Nursing facilities designated as of July 1, 2012 by | 14 | | the Department as "Institutions for Mental Disease" shall | 15 | | be excluded from all calculations under this subsection. | 16 | | The data from these facilities shall not be used in the | 17 | | computations described in paragraphs (1) through (4) above | 18 | | to establish the base rate. | 19 | | (e) Beginning July 1, 2014, the Department shall allocate | 20 | | funding in the amount up to $10,000,000 for per diem add-ons to | 21 | | the RUGS methodology for dates of service on and after July 1, | 22 | | 2014: | 23 | | (1) $0.63 for each resident who scores in I4200 | 24 | | Alzheimer's Disease or I4800 non-Alzheimer's Dementia. | 25 | | (2) $2.67 for each resident who scores either a "1" or | 26 | | "2" in any items S1200A through S1200I and also scores in |
| | | SB3526 | - 5 - | LRB101 17781 KTG 67209 b |
|
| 1 | | RUG groups PA1, PA2, BA1, or BA2. | 2 | | (e-1) (Blank). | 3 | | (e-2) For dates of services beginning January 1, 2014, the | 4 | | RUG-IV nursing component per diem for a nursing home shall be | 5 | | the product of the statewide RUG-IV nursing base per diem rate, | 6 | | the facility average case mix index, and the regional wage | 7 | | adjustor. Transition rates for services provided between | 8 | | January 1, 2014 and December 31, 2014 shall be as follows: | 9 | | (1) The transition RUG-IV per diem nursing rate for | 10 | | nursing homes whose rate calculated in this subsection | 11 | | (e-2) is greater than the nursing component rate in effect | 12 | | July 1, 2012 shall be paid the sum of: | 13 | | (A) The nursing component rate in effect July 1, | 14 | | 2012; plus | 15 | | (B) The difference of the RUG-IV nursing component | 16 | | per diem calculated for the current quarter minus the | 17 | | nursing component rate in effect July 1, 2012 | 18 | | multiplied by 0.88. | 19 | | (2) The transition RUG-IV per diem nursing rate for | 20 | | nursing homes whose rate calculated in this subsection | 21 | | (e-2) is less than the nursing component rate in effect | 22 | | July 1, 2012 shall be paid the sum of: | 23 | | (A) The nursing component rate in effect July 1, | 24 | | 2012; plus | 25 | | (B) The difference of the RUG-IV nursing component | 26 | | per diem calculated for the current quarter minus the |
| | | SB3526 | - 6 - | LRB101 17781 KTG 67209 b |
|
| 1 | | nursing component rate in effect July 1, 2012 | 2 | | multiplied by 0.13. | 3 | | (f) Notwithstanding any other provision of this Code, on | 4 | | and after July 1, 2012, reimbursement rates associated with the | 5 | | nursing or support components of the current nursing facility | 6 | | rate methodology shall not increase beyond the level effective | 7 | | May 1, 2011 until a new reimbursement system based on the RUGs | 8 | | IV 48 grouper model has been fully operationalized. | 9 | | (g) Notwithstanding any other provision of this Code, on | 10 | | and after July 1, 2012, for facilities not designated by the | 11 | | Department of Healthcare and Family Services as "Institutions | 12 | | for Mental Disease", rates effective May 1, 2011 shall be | 13 | | adjusted as follows: | 14 | | (1) Individual nursing rates for residents classified | 15 | | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | 16 | | ending March 31, 2012 shall be reduced by 10%; | 17 | | (2) Individual nursing rates for residents classified | 18 | | in all other RUG IV groups shall be reduced by 1.0%; | 19 | | (3) Facility rates for the capital and support | 20 | | components shall be reduced by 1.7%. | 21 | | (h) Notwithstanding any other provision of this Code, on | 22 | | and after July 1, 2012, nursing facilities designated by the | 23 | | Department of Healthcare and Family Services as "Institutions | 24 | | for Mental Disease" and "Institutions for Mental Disease" that | 25 | | are facilities licensed under the Specialized Mental Health | 26 | | Rehabilitation Act of 2013 shall have the nursing, |
| | | SB3526 | - 7 - | LRB101 17781 KTG 67209 b |
|
| 1 | | socio-developmental, capital, and support components of their | 2 | | reimbursement rate effective May 1, 2011 reduced in total by | 3 | | 2.7%. | 4 | | (i) On and after July 1, 2014, the reimbursement rates for | 5 | | the support component of the nursing facility rate for | 6 | | facilities licensed under the Nursing Home Care Act as skilled | 7 | | or intermediate care facilities shall be the rate in effect on | 8 | | June 30, 2014 increased by 8.17%. | 9 | | (j) Notwithstanding any other provision of law, subject to | 10 | | federal approval, effective July 1, 2019, sufficient funds | 11 | | shall be allocated for changes to rates for facilities licensed | 12 | | under the Nursing Home Care Act as skilled nursing facilities | 13 | | or intermediate care facilities for dates of services on and | 14 | | after July 1, 2019: (i) to establish a per diem add-on to the | 15 | | direct care per diem rate not to exceed $70,000,000 annually in | 16 | | the aggregate taking into account federal matching funds for | 17 | | the purpose of addressing the facility's unique staffing needs, | 18 | | adjusted quarterly and distributed by a weighted formula based | 19 | | on Medicaid bed days on the last day of the second quarter | 20 | | preceding the quarter for which the rate is being adjusted; and | 21 | | (ii) in an amount not to exceed $170,000,000 annually in the | 22 | | aggregate taking into account federal matching funds to permit | 23 | | the support component of the nursing facility rate to be | 24 | | updated as follows: | 25 | | (1) 80%, or $136,000,000, of the funds shall be used to | 26 | | update each facility's rate in effect on June 30, 2019 |
| | | SB3526 | - 8 - | LRB101 17781 KTG 67209 b |
|
| 1 | | using the most recent cost reports on file, which have had | 2 | | a limited review conducted by the Department of Healthcare | 3 | | and Family Services and will not hold up enacting the rate | 4 | | increase, with the Department of Healthcare and Family | 5 | | Services and taking into account subsection (i). | 6 | | (2) After completing the calculation in paragraph (1), | 7 | | any facility whose rate is less than the rate in effect on | 8 | | June 30, 2019 shall have its rate restored to the rate in | 9 | | effect on June 30, 2019 from the 20% of the funds set | 10 | | aside. | 11 | | (3) The remainder of the 20%, or $34,000,000, shall be | 12 | | used to increase each facility's rate by an equal | 13 | | percentage. | 14 | | To implement item (i) in this subsection, facilities shall | 15 | | file quarterly reports documenting compliance with its | 16 | | annually approved staffing plan, which shall permit compliance | 17 | | with Section 3-202.05 of the Nursing Home Care Act. A facility | 18 | | that fails to meet the benchmarks and dates contained in the | 19 | | plan may have its add-on adjusted in the quarter following the | 20 | | quarterly review. Nothing in this Section shall limit the | 21 | | ability of the facility to appeal a ruling of non-compliance | 22 | | and a subsequent reduction to the add-on. Funds adjusted for | 23 | | noncompliance shall be maintained in the Long-Term Care | 24 | | Provider Fund and accounted for separately. At the end of each | 25 | | fiscal year, these funds shall be made available to facilities | 26 | | for special staffing projects. |
| | | SB3526 | - 9 - | LRB101 17781 KTG 67209 b |
|
| 1 | | In order to provide for the expeditious and timely
| 2 | | implementation of the provisions of Public Act 101-10 this | 3 | | amendatory Act of the
101st General Assembly , emergency rules | 4 | | to implement any provision of Public Act 101-10 this amendatory | 5 | | Act of the 101st General Assembly may be adopted in accordance | 6 | | with this subsection by the agency charged with administering | 7 | | that provision or
initiative. The agency shall simultaneously | 8 | | file emergency rules and permanent rules to ensure that there | 9 | | is no interruption in administrative guidance. The 150-day | 10 | | limitation of the effective period of emergency rules does not | 11 | | apply to rules adopted under this
subsection, and the effective | 12 | | period may continue through
June 30, 2021. The 24-month | 13 | | limitation on the adoption of
emergency rules does not apply to | 14 | | rules adopted under this
subsection. The adoption of emergency | 15 | | rules authorized by this subsection is deemed to be necessary | 16 | | for the public interest, safety, and welfare. | 17 | | (k) (j) During the first quarter of State Fiscal Year 2020, | 18 | | the Department of Healthcare of Family Services must convene a | 19 | | technical advisory group consisting of members of all trade | 20 | | associations representing Illinois skilled nursing providers | 21 | | to discuss changes necessary with federal implementation of | 22 | | Medicare's Patient-Driven Payment Model. Implementation of | 23 | | Medicare's Patient-Driven Payment Model shall, by September 1, | 24 | | 2020, end the collection of the MDS data that is necessary to | 25 | | maintain the current RUG-IV Medicaid payment methodology. The | 26 | | technical advisory group must consider a revised reimbursement |
| | | SB3526 | - 10 - | LRB101 17781 KTG 67209 b |
|
| 1 | | methodology that takes into account transparency, | 2 | | accountability, actual staffing as reported under the | 3 | | federally required Payroll Based Journal system, changes to the | 4 | | minimum wage, adequacy in coverage of the cost of care, and a | 5 | | quality component that rewards quality improvements. | 6 | | (Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19; | 7 | | revised 9-18-19.)
| 8 | | Section 99. Effective date. This Act takes effect upon | 9 | | becoming law.
|
|