Illinois General Assembly - Full Text of HB0246
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Full Text of HB0246  102nd General Assembly

HB0246sam001 102ND GENERAL ASSEMBLY

Sen. Ann Gillespie

Filed: 4/6/2022

 

 


 

 


 
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1
AMENDMENT TO HOUSE BILL 246

2    AMENDMENT NO. ______. Amend House Bill 246 by replacing
3everything after the enacting clause with the following:
 
4    "Section 1. The Illinois Administrative Procedure Act is
5amended by adding Section 5-45.21 as follows:
 
6    (5 ILCS 100/5-45.21 new)
7    Sec. 5-45.21. Emergency rulemaking; Department of
8Healthcare and Family Services. To provide for the expeditious
9and timely implementation of the changes made to Articles 5
10and 5B of the Illinois Public Aid Code by this amendatory Act
11of the 102nd General Assembly, emergency rules implementing
12the changes made to Articles 5 and 5B of the Illinois Public
13Aid Code by this amendatory Act of the 102nd General Assembly
14may be adopted in accordance with Section 5-45 by the
15Department of Healthcare and Family Services. The adoption of
16emergency rules authorized by Section 5-45 and this Section is

 

 

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1deemed to be necessary for the public interest, safety, and
2welfare.
3    This Section is repealed on September 30, 2022.
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 5-5.2, 5-5.8, 5B-2, 5B-4, 5B-5, 5B-8, and
65E-10 and by adding Section 5E-20 as follows:
 
7    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)
8    Sec. 5-5.2. Payment.
9    (a) All nursing facilities that are grouped pursuant to
10Section 5-5.1 of this Act shall receive the same rate of
11payment for similar services.
12    (b) It shall be a matter of State policy that the Illinois
13Department shall utilize a uniform billing cycle throughout
14the State for the long-term care providers.
15    (c) (Blank). Notwithstanding any other provisions of this
16Code, the methodologies for reimbursement of nursing services
17as provided under this Article shall no longer be applicable
18for bills payable for nursing services rendered on or after a
19new reimbursement system based on the Resource Utilization
20Groups (RUGs) has been fully operationalized, which shall take
21effect for services provided on or after January 1, 2014.
22    (c-1) Notwithstanding any other provisions of this Code,
23the methodologies for reimbursement of nursing services as
24provided under this Article shall no longer be applicable for

 

 

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1bills payable for nursing services rendered on or after a new
2reimbursement system based on the Patient Driven Payment Model
3(PDPM) has been fully operationalized, which shall take effect
4for services provided on or after the implementation of the
5PDPM reimbursement system begins. For the purposes of this
6amendatory Act of the 102nd General Assembly, the
7implementation date of the PDPM reimbursement system and all
8related provisions shall be July 1, 2022 if the following
9conditions are met: (i) the Centers for Medicare and Medicaid
10Services has approved corresponding changes in the
11reimbursement system and bed assessment; and (ii) the
12Department has filed rules to implement these changes no later
13than June 1, 2022. Failure of the Department to file rules to
14implement the changes provided in this amendatory Act of the
15102nd General Assembly no later than June 1, 2022 shall result
16in the implementation date being delayed to October 1, 2022.
17    (d) The new nursing services reimbursement methodology
18utilizing the Patient Driven Payment Model RUG-IV 48 grouper
19model, which shall be referred to as the PDPM RUGs
20reimbursement system, taking effect July 1, 2022, upon federal
21approval by the Centers for Medicare and Medicaid Services
22January 1, 2014, shall be based on the following:
23        (1) The methodology shall be resident-centered
24    resident-driven, facility-specific, cost-based, and based
25    on guidance from the Centers for Medicare and Medicaid
26    Services and cost-based.

 

 

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1        (2) Costs shall be annually rebased and case mix index
2    quarterly updated. The nursing services methodology will
3    be assigned to the Medicaid enrolled residents on record
4    as of 30 days prior to the beginning of the rate period in
5    the Department's Medicaid Management Information System
6    (MMIS) as present on the last day of the second quarter
7    preceding the rate period based upon the Assessment
8    Reference Date of the Minimum Data Set (MDS).
9        (3) Regional wage adjustors based on the Health
10    Service Areas (HSA) groupings and adjusters in effect on
11    April 30, 2012 shall be included, except no adjuster shall
12    be lower than 1.06 1.0.
13        (4) PDPM nursing case mix indices in effect on March
14    1, 2022 Case mix index shall be assigned to each resident
15    class at no less than 0.7858 of based on the Centers for
16    Medicare and Medicaid Services PDPM unadjusted case mix
17    values, in effect on March 1, 2022, staff time measurement
18    study in effect on July 1, 2013, utilizing an index
19    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        (6) The Department shall establish a variable per diem
24    staffing add-on in accordance with the most recent
25    available federal staffing report, currently the Payroll
26    Based Journal, for the same period of time, and if

 

 

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1    applicable adjusted for acuity using the same quarter's
2    MDS. The Department shall rely on Payroll Based Journals
3    provided to the Department of Public Health to make a
4    determination of non-submission. If the Department is
5    notified by a facility of missing or inaccurate Payroll
6    Based Journal data or an incorrect calculation of
7    staffing, the Department must make a correction as soon as
8    the error is verified for the applicable quarter.
9        Facilities with at least 70% of the staffing indicated
10    by the STRIVE study shall be paid a per diem add-on of $9,
11    increasing by equivalent steps for each whole percentage
12    point until the facilities reach a per diem of $14.88.
13    Facilities with at least 80% of the staffing indicated by
14    the STRIVE study shall be paid a per diem add-on of $14.88,
15    increasing by equivalent steps for each whole percentage
16    point until the facilities reach a per diem add-on of
17    $23.80. Facilities with at least 92% of the staffing
18    indicated by the STRIVE study shall be paid a per diem
19    add-on of $23.80, increasing by equivalent steps for each
20    whole percentage point until the facilities reach a per
21    diem add-on of $29.75. Facilities with at least 100% of
22    the staffing indicated by the STRIVE study shall be paid a
23    per diem add-on of $29.75, increasing by equivalent steps
24    for each whole percentage point until the facilities reach
25    a per diem add-on of $35.70. Facilities with at least 110%
26    of the staffing indicated by the STRIVE study shall be

 

 

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1    paid a per diem add-on of $35.70, increasing by equivalent
2    steps for each whole percentage point until the facilities
3    reach a per diem add-on of $38.68. Facilities with at
4    least 125% or higher of the staffing indicated by the
5    STRIVE study shall be paid a per diem add-on of $38.68.
6    Beginning April 1, 2023, no nursing facility's variable
7    staffing per diem add-on shall be reduced by more than 5%
8    in 2 consecutive quarters. For the quarters beginning July
9    1, 2022 and October 1, 2022, no facility's variable per
10    diem staffing add-on shall be calculated at a rate lower
11    than 85% of the staffing indicated by the STRIVE study. No
12    facility below 70% of the staffing indicated by the STRIVE
13    study shall receive a variable per diem staffing add-on
14    after December 31, 2022.
15        (7) For dates of services beginning July 1, 2022, the
16    PDPM nursing component per diem for each nursing facility
17    shall be the product of the facility's (i) statewide PDPM
18    nursing base per diem rate, $92.25, adjusted for the
19    facility average PDPM case mix index calculated quarterly
20    and (ii) the regional wage adjuster, and then add the
21    Medicaid access adjustment as defined in (e-3) of this
22    Section. Transition rates for services provided between
23    July 1, 2022 and October 1, 2023 shall be the greater of
24    the PDPM nursing component per diem or:
25            (A) for the quarter beginning July 1, 2022, the
26        RUG-IV nursing component per diem;

 

 

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1            (B) for the quarter beginning October 1, 2022, the
2        sum of the RUG-IV nursing component per diem
3        multiplied by 0.80 and the PDPM nursing component per
4        diem multiplied by 0.20;
5            (C) for the quarter beginning January 1, 2023, the
6        sum of the RUG-IV nursing component per diem
7        multiplied by 0.60 and the PDPM nursing component per
8        diem multiplied by 0.40;
9            (D) for the quarter beginning April 1, 2023, the
10        sum of the RUG-IV nursing component per diem
11        multiplied by 0.40 and the PDPM nursing component per
12        diem multiplied by 0.60;
13            (E) for the quarter beginning July 1, 2023, the
14        sum of the RUG-IV nursing component per diem
15        multiplied by 0.20 and the PDPM nursing component per
16        diem multiplied by 0.80; or
17            (F) for the quarter beginning October 1, 2023 and
18        each subsequent quarter, the transition rate shall end
19        and a nursing facility shall be paid 100% of the PDPM
20        nursing component per diem.
21    (d-1) Calculation of base year Statewide RUG-IV nursing
22base per diem rate.
23    (1) Base rate spending pool shall be:
24        (A) The base year resident days which are calculated
25    by multiplying the number of Medicaid residents in each
26    nursing home as indicated in the MDS data defined in

 

 

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1    paragraph (4) by 365.
2        (B) Each facility's nursing component per diem in
3    effect on July 1, 2012 shall be multiplied by subsection
4    (A).
5            (C) Thirteen million is added to the product of
6        subparagraph (A) and subparagraph (B) to adjust for
7        the exclusion of nursing homes defined in paragraph
8        (5).
9        (2) For each nursing home with Medicaid residents as
10    indicated by the MDS data defined in paragraph (4),
11    weighted days adjusted for case mix and regional wage
12    adjustment shall be calculated. For each home this
13    calculation is the product of:
14            (A) Base year resident days as calculated in
15        subparagraph (A) of paragraph (1).
16            (B) The nursing home's regional wage adjustor
17        based on the Health Service Areas (HSA) groupings and
18        adjustors in effect on April 30, 2012.
19            (C) Facility weighted case mix which is the number
20        of Medicaid residents as indicated by the MDS data
21        defined in paragraph (4) multiplied by the associated
22        case weight for the RUG-IV 48 grouper model using
23        standard RUG-IV procedures for index maximization.
24            (D) The sum of the products calculated for each
25        nursing home in subparagraphs (A) through (C) above
26        shall be the base year case mix, rate adjusted

 

 

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1        weighted days.
2        (3) The Statewide RUG-IV nursing base per diem rate:
3            (A) on January 1, 2014 shall be the quotient of the
4        paragraph (1) divided by the sum calculated under
5        subparagraph (D) of paragraph (2); and
6            (B) on and after July 1, 2014 and until July 1,
7        2022, shall be the amount calculated under
8        subparagraph (A) of this paragraph (3) plus $1.76; and
9        .
10            (C) beginning July 1, 2022 and thereafter, $7
11        shall be added to the amount calculated under
12        subparagraph (B) of this paragraph (3) of this
13        Section.
14        (4) Minimum Data Set (MDS) comprehensive assessments
15    for Medicaid residents on the last day of the quarter used
16    to establish the base rate.
17        (5) Nursing facilities designated as of July 1, 2012
18    by the Department as "Institutions for Mental Disease"
19    shall be excluded from all calculations under this
20    subsection. The data from these facilities shall not be
21    used in the computations described in paragraphs (1)
22    through (4) above to establish the base rate.
23    (e) Beginning July 1, 2014, the Department shall allocate
24funding in the amount up to $10,000,000 for per diem add-ons to
25the RUGS methodology for dates of service on and after July 1,
262014:

 

 

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1        (1) $0.63 for each resident who scores in I4200
2    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
3        (2) $2.67 for each resident who scores either a "1" or
4    "2" in any items S1200A through S1200I and also scores in
5    RUG groups PA1, PA2, BA1, or BA2.
6    (e-1) (Blank).
7    (e-2) For dates of services beginning January 1, 2014 and
8ending September 30, 2023, the RUG-IV nursing component per
9diem for a nursing home shall be the product of the statewide
10RUG-IV nursing base per diem rate, the facility average case
11mix index, and the regional wage adjustor. Transition rates
12for services provided between January 1, 2014 and December 31,
132014 shall be as follows:
14        (1) The transition RUG-IV per diem nursing rate for
15    nursing homes whose rate calculated in this subsection
16    (e-2) is greater than the nursing component rate in effect
17    July 1, 2012 shall be paid the sum of:
18            (A) The nursing component rate in effect July 1,
19        2012; plus
20            (B) The difference of the RUG-IV nursing component
21        per diem calculated for the current quarter minus the
22        nursing component rate in effect July 1, 2012
23        multiplied by 0.88.
24        (2) The transition RUG-IV per diem nursing rate for
25    nursing homes whose rate calculated in this subsection
26    (e-2) is less than the nursing component rate in effect

 

 

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1    July 1, 2012 shall be paid the sum of:
2            (A) The nursing component rate in effect July 1,
3        2012; plus
4            (B) The difference of the RUG-IV nursing component
5        per diem calculated for the current quarter minus the
6        nursing component rate in effect July 1, 2012
7        multiplied by 0.13.
8    (e-3) A Medicaid Access Adjustment of $4 adjusted for the
9facility average PDPM case mix index calculated quarterly
10shall be added to the statewide PDPM nursing per diem for all
11facilities with annual Medicaid bed days of at least 70% of all
12occupied bed days adjusted quarterly. For each new calendar
13year and for the 6-month period beginning July 1, 2022, the
14percentage of a facility's occupied bed days comprised of
15Medicaid bed days shall be determined by the Department
16quarterly. This subsection shall be inoperative on and after
17January 1, 2028.
18    (f) (Blank). Notwithstanding any other provision of this
19Code, on and after July 1, 2012, reimbursement rates
20associated with the nursing or support components of the
21current nursing facility rate methodology shall not increase
22beyond the level effective May 1, 2011 until a new
23reimbursement system based on the RUGs IV 48 grouper model has
24been fully operationalized.
25    (g) Notwithstanding any other provision of this Code, on
26and after July 1, 2012, for facilities not designated by the

 

 

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1Department of Healthcare and Family Services as "Institutions
2for Mental Disease", rates effective May 1, 2011 shall be
3adjusted as follows:
4        (1) (Blank); Individual nursing rates for residents
5    classified in RUG IV groups PA1, PA2, BA1, and BA2 during
6    the quarter ending March 31, 2012 shall be reduced by 10%;
7        (2) (Blank); Individual nursing rates for residents
8    classified in all other RUG IV groups shall be reduced by
9    1.0%;
10        (3) Facility rates for the capital and support
11    components shall be reduced by 1.7%.
12    (h) Notwithstanding any other provision of this Code, on
13and after July 1, 2012, nursing facilities designated by the
14Department of Healthcare and Family Services as "Institutions
15for Mental Disease" and "Institutions for Mental Disease" that
16are facilities licensed under the Specialized Mental Health
17Rehabilitation Act of 2013 shall have the nursing,
18socio-developmental, capital, and support components of their
19reimbursement rate effective May 1, 2011 reduced in total by
202.7%.
21    (i) On and after July 1, 2014, the reimbursement rates for
22the support component of the nursing facility rate for
23facilities licensed under the Nursing Home Care Act as skilled
24or intermediate care facilities shall be the rate in effect on
25June 30, 2014 increased by 8.17%.
26    (j) Notwithstanding any other provision of law, subject to

 

 

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1federal approval, effective July 1, 2019, sufficient funds
2shall be allocated for changes to rates for facilities
3licensed under the Nursing Home Care Act as skilled nursing
4facilities or intermediate care facilities for dates of
5services on and after July 1, 2019: (i) to establish, through
6June 30, 2022 a per diem add-on to the direct care per diem
7rate not to exceed $70,000,000 annually in the aggregate
8taking into account federal matching funds for the purpose of
9addressing the facility's unique staffing needs, adjusted
10quarterly and distributed by a weighted formula based on
11Medicaid bed days on the last day of the second quarter
12preceding the quarter for which the rate is being adjusted.
13Beginning July 1, 2022, the annual $70,000,000 described in
14the preceding sentence shall be dedicated to the variable per
15diem add-on for staffing under paragraph (6) of subsection
16(d); and (ii) in an amount not to exceed $170,000,000 annually
17in the aggregate taking into account federal matching funds to
18permit the support component of the nursing facility rate to
19be updated as follows:
20        (1) 80%, or $136,000,000, of the funds shall be used
21    to update each facility's rate in effect on June 30, 2019
22    using the most recent cost reports on file, which have had
23    a limited review conducted by the Department of Healthcare
24    and Family Services and will not hold up enacting the rate
25    increase, with the Department of Healthcare and Family
26    Services and taking into account subsection (i).

 

 

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1        (2) After completing the calculation in paragraph (1),
2    any facility whose rate is less than the rate in effect on
3    June 30, 2019 shall have its rate restored to the rate in
4    effect on June 30, 2019 from the 20% of the funds set
5    aside.
6        (3) The remainder of the 20%, or $34,000,000, shall be
7    used to increase each facility's rate by an equal
8    percentage.
9    To implement item (i) in this subsection, facilities shall
10file quarterly reports documenting compliance with its
11annually approved staffing plan, which shall permit compliance
12with Section 3-202.05 of the Nursing Home Care Act. A facility
13that fails to meet the benchmarks and dates contained in the
14plan may have its add-on adjusted in the quarter following the
15quarterly review. Nothing in this Section shall limit the
16ability of the facility to appeal a ruling of non-compliance
17and a subsequent reduction to the add-on. Funds adjusted for
18noncompliance shall be maintained in the Long-Term Care
19Provider Fund and accounted for separately. At the end of each
20fiscal year, these funds shall be made available to facilities
21for special staffing projects.
22    In order to provide for the expeditious and timely
23implementation of the provisions of Public Act 101-10,
24emergency rules to implement any provision of Public Act
25101-10 may be adopted in accordance with this subsection by
26the agency charged with administering that provision or

 

 

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1initiative. The agency shall simultaneously file emergency
2rules and permanent rules to ensure that there is no
3interruption in administrative guidance. The 150-day
4limitation of the effective period of emergency rules does not
5apply to rules adopted under this subsection, and the
6effective period may continue through June 30, 2021. The
724-month limitation on the adoption of emergency rules does
8not apply to rules adopted under this subsection. The adoption
9of emergency rules authorized by this subsection is deemed to
10be necessary for the public interest, safety, and welfare.
11    (k) During the first quarter of State Fiscal Year 2020,
12the Department of Healthcare of Family Services must convene a
13technical advisory group consisting of members of all trade
14associations representing Illinois skilled nursing providers
15to discuss changes necessary with federal implementation of
16Medicare's Patient-Driven Payment Model. Implementation of
17Medicare's Patient-Driven Payment Model shall, by September 1,
182020, end the collection of the MDS data that is necessary to
19maintain the current RUG-IV Medicaid payment methodology. The
20technical advisory group must consider a revised reimbursement
21methodology that takes into account transparency,
22accountability, actual staffing as reported under the
23federally required Payroll Based Journal system, changes to
24the minimum wage, adequacy in coverage of the cost of care, and
25a quality component that rewards quality improvements.
26    (l) The Department shall establish per diem add-on

 

 

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1payments to improve the quality of care delivered by
2facilities, including:
3        (1) Incentive payments determined by facility
4    performance on specified quality measures in an initial
5    amount of $70,000,000. Nothing in this subsection shall be
6    construed to limit the quality of care payments in the
7    aggregate statewide to $70,000,000, and, if quality of
8    care has improved across nursing facilities, the
9    Department shall adjust those add-on payments accordingly.
10    The quality payment methodology described in this
11    subsection must be used for at least State Fiscal Year
12    2023. Beginning with the quarter starting July 1, 2023,
13    the Department may add, remove, or change quality metrics
14    and make associated changes to the quality payment
15    methodology as outlined in subparagraph (E). Facilities
16    designated by the Centers for Medicare and Medicaid
17    Services as a special focus facility or a hospital-based
18    nursing home do not qualify for quality payments.
19            (A) Each quality pool must be distributed by
20        assigning a quality weighted score for each nursing
21        home which is calculated by multiplying the nursing
22        home's quality base period Medicaid days by the
23        nursing home's star rating weight in that period.
24            (B) Star rating weights are assigned based on the
25        nursing home's star rating for the LTS quality star
26        rating. As used in this subparagraph, "LTS quality

 

 

10200HB0246sam001- 17 -LRB102 10452 KTG 38673 a

1        star rating" means the long-term stay quality rating
2        for each nursing facility, as assigned by the Centers
3        for Medicare and Medicaid Services under the Five-Star
4        Quality Rating System. The rating is a number ranging
5        from 0 (lowest) to 5 (highest).
6                (i) Zero-star or one-star rating has a weight
7            of 0.
8                (ii) Two-star rating has a weight of 0.75.
9                (iii) Three-star rating has a weight of 1.5.
10                (iv) Four-star rating has a weight of 2.5.
11                (v) Five-star rating has a weight of 3.5.
12            (C) Each nursing home's quality weight score is
13        divided by the sum of all quality weight scores for
14        qualifying nursing homes to determine the proportion
15        of the quality pool to be paid to the nursing home.
16            (D) The quality pool is no less than $70,000,000
17        annually or $17,500,000 per quarter. The Department
18        shall publish on its website the estimated payments
19        and the associated weights for each facility 45 days
20        prior to when the initial payments for the quarter are
21        to be paid. The Department shall assign each facility
22        the most recent and applicable quarter's STAR value
23        unless the facility notifies the Department within 15
24        days of an issue and the facility provides reasonable
25        evidence demonstrating its timely compliance with
26        federal data submission requirements for the quarter

 

 

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1        of record. If such evidence cannot be provided to the
2        Department, the STAR rating assigned to the facility
3        shall be reduced by one from the prior quarter.
4            (E) The Department shall review quality metrics
5        used for payment of the quality pool and make
6        recommendations for any associated changes to the
7        methodology for distributing quality pool payments in
8        consultation with associations representing long-term
9        care providers, consumer advocates, organizations
10        representing workers of long-term care facilities, and
11        payors. The Department may establish, by rule, changes
12        to the methodology for distributing quality pool
13        payments.
14            (F) The Department shall disburse quality pool
15        payments from the Long-Term Care Provider Fund on a
16        monthly basis in amounts proportional to the total
17        quality pool payment determined for the quarter.
18            (G) The Department shall publish any changes in
19        the methodology for distributing quality pool payments
20        prior to the beginning of the measurement period or
21        quality base period for any metric added to the
22        distribution's methodology.
23        (2) Payments based on CNA tenure, promotion, and CNA
24    training for the purpose of increasing CNA compensation.
25    It is the intent of this subsection that payments made in
26    accordance with this paragraph be directly incorporated

 

 

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1    into increased compensation for CNAs. As used in this
2    paragraph, "CNA" means a certified nursing assistant as
3    that term is described in Section 3-206 of the Nursing
4    Home Care Act, Section 3-206 of the ID/DD Community Care
5    Act, and Section 3-206 of the MC/DD Act. The Department
6    shall establish, by rule, payments to nursing facilities
7    equal to Medicaid's share of the tenure wage increments
8    specified in this paragraph for all reported CNA employee
9    hours compensated according to a posted schedule
10    consisting of increments at least as large as those
11    specified in this paragraph. The increments are as
12    follows: an additional $1.50 per hour for CNAs with at
13    least one and less than 2 years' experience plus another
14    $1 per hour for each additional year of experience up to a
15    maximum of $6.50 for CNAs with at least 6 years of
16    experience. For purposes of this paragraph, Medicaid's
17    share shall be the ratio determined by paid Medicaid bed
18    days divided by total bed days for the applicable time
19    period used in the calculation. In addition, and additive
20    to any tenure increments paid as specified in this
21    paragraph, the Department shall establish, by rule,
22    payments supporting Medicaid's share of the
23    promotion-based wage increments for CNA employee hours
24    compensated for that promotion with at least a $1.50
25    hourly increase. Medicaid's share shall be established as
26    it is for the tenure increments described in this

 

 

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1    paragraph. Qualifying promotions shall be defined by the
2    Department in rules for an expected 10-15% subset of CNAs
3    assigned intermediate, specialized, or added roles such as
4    CNA trainers, CNA scheduling "captains", and CNA
5    specialists for resident conditions like dementia or
6    memory care or behavioral health.
7    (m) The Department shall work with nursing facility
8industry representatives to design policies and procedures to
9permit facilities to address the integrity of data from
10federal reporting sites used by the Department in setting
11facility rates.
12(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
13102-77, eff. 7-9-21; 102-558, eff. 8-20-21.)
 
14    (305 ILCS 5/5-5.8)  (from Ch. 23, par. 5-5.8)
15    Sec. 5-5.8. Report on nursing home reimbursement. The
16Illinois Department shall report annually to the General
17Assembly, no later than the first Monday in April of 1982, and
18each year thereafter, in regard to:
19        (a) the rate structure used by the Illinois Department
20    to reimburse nursing facilities;
21        (b) changes in the rate structure for reimbursing
22    nursing facilities;
23        (c) the administrative and program costs of
24    reimbursing nursing facilities;
25        (d) the availability of beds in nursing facilities for

 

 

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1    public aid recipients; and
2        (e) the number of closings of nursing facilities, and
3    the reasons for those closings; and .
4        (f) for years beginning 2025 and thereafter, drawing
5    on all available information that evaluates, to the extent
6    possible, nursing facility costs and revenue, including a
7    focus on the period of initial implementation of the
8    payments and programs authorized in this Act.
9    The requirement for reporting to the General Assembly
10shall be satisfied by filing copies of the report as required
11by Section 3.1 of the General Assembly Organization Act, and
12filing such additional copies with the State Government Report
13Distribution Center for the General Assembly as is required
14under paragraph (t) of Section 7 of the State Library Act.
15(Source: P.A. 100-1148, eff. 12-10-18.)
 
16    (305 ILCS 5/5B-2)  (from Ch. 23, par. 5B-2)
17    Sec. 5B-2. Assessment; no local authorization to tax.
18    (a) For the privilege of engaging in the occupation of
19long-term care provider, beginning July 1, 2011 through June
2030, 2022, or upon federal approval by the Centers for Medicare
21and Medicaid Services of the long-term care provider
22assessment described in subsection (a-1), whichever is later,
23an assessment is imposed upon each long-term care provider in
24an amount equal to $6.07 times the number of occupied bed days
25due and payable each month. Notwithstanding any provision of

 

 

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1any other Act to the contrary, this assessment shall be
2construed as a tax, but shall not be billed or passed on to any
3resident of a nursing home operated by the nursing home
4provider.
5    (a-1) For the privilege of engaging in the occupation of
6long-term care provider for each occupied non-Medicare bed
7day, beginning July 1, 2022, an assessment is imposed upon
8each long-term care provider in an amount varying with the
9number of paid Medicaid resident days per annum in the
10facility with the following schedule of occupied bed tax
11amounts. This assessment is due and payable each month. The
12tax shall follow the schedule below and be rebased by the
13Department on an annual basis. The Department shall publish
14each facility's rebased tax rate according to the schedule in
15this Section 30 days prior to the beginning of the 6-month
16period beginning July 1, 2022 and thereafter 30 days prior to
17the beginning of each calendar year which shall incorporate
18the number of paid Medicaid days used to determine each
19facility's rebased tax rate.
20        (1) 0-5,000 paid Medicaid resident days per annum,
21    $10.67.
22        (2) 5,001-15,000 paid Medicaid resident days per
23    annum, $19.20.
24        (3) 15,001-35,000 paid Medicaid resident days per
25    annum, $22.40.
26        (4) 35,001-55,000 paid Medicaid resident days per

 

 

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1    annum, $19.20.
2        (5) 55,001-65,000 paid Medicaid resident days per
3    annum, $13.86.
4        (6) 65,001+ paid Medicaid resident days per annum,
5    $10.67.
6        (7) Any non-profit nursing facilities without
7    Medicaid-certified beds, $7 per occupied bed day.
8    Notwithstanding any provision of any other Act to the
9contrary, this assessment shall be construed as a tax but
10shall not be billed or passed on to any resident of a nursing
11home operated by the nursing home provider.
12    For each new calendar year and for the 6-month period
13beginning July 1, 2022, a facility's paid Medicaid resident
14days per annum shall be determined using the Department's
15Medicaid Management Information System to include Medicaid
16resident days for the year ending 9 months earlier.
17    (b) Nothing in this amendatory Act of 1992 shall be
18construed to authorize any home rule unit or other unit of
19local government to license for revenue or impose a tax or
20assessment upon long-term care providers or the occupation of
21long-term care provider, or a tax or assessment measured by
22the income or earnings or occupied bed days of a long-term care
23provider.
24    (c) The assessment imposed by this Section shall not be
25due and payable, however, until after the Department notifies
26the long-term care providers, in writing, that the payment

 

 

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1methodologies to long-term care providers required under
2Section 5-5.2 5-5.4 of this Code have been approved by the
3Centers for Medicare and Medicaid Services of the U.S.
4Department of Health and Human Services and that the waivers
5under 42 CFR 433.68 for the assessment imposed by this
6Section, if necessary, have been granted by the Centers for
7Medicare and Medicaid Services of the U.S. Department of
8Health and Human Services.
9(Source: P.A. 96-1530, eff. 2-16-11; 97-10, eff. 6-14-11;
1097-584, eff. 8-26-11.)
 
11    (305 ILCS 5/5B-4)  (from Ch. 23, par. 5B-4)
12    Sec. 5B-4. Payment of assessment; penalty.
13    (a) The assessment imposed by Section 5B-2 shall be due
14and payable monthly, on the last State business day of the
15month for occupied bed days reported for the preceding third
16month prior to the month in which the tax is payable and due. A
17facility that has delayed payment due to the State's failure
18to reimburse for services rendered may request an extension on
19the due date for payment pursuant to subsection (b) and shall
20pay the assessment within 30 days of reimbursement by the
21Department. The Illinois Department may provide that county
22nursing homes directed and maintained pursuant to Section
235-1005 of the Counties Code may meet their assessment
24obligation by certifying to the Illinois Department that
25county expenditures have been obligated for the operation of

 

 

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1the county nursing home in an amount at least equal to the
2amount of the assessment.
3    (a-5) The Illinois Department shall provide for an
4electronic submission process for each long-term care facility
5to report at a minimum the number of occupied bed days of the
6long-term care facility for the reporting period and other
7reasonable information the Illinois Department requires for
8the administration of its responsibilities under this Code.
9Beginning July 1, 2013, a separate electronic submission shall
10be completed for each long-term care facility in this State
11operated by a long-term care provider. The Illinois Department
12shall provide a self-reporting notice of the assessment form
13that the long-term care facility completes for the required
14period and submits with its assessment payment to the Illinois
15Department. To the extent practicable, the Department shall
16coordinate the assessment reporting requirements with other
17reporting required of long-term care facilities.
18    (b) The Illinois Department is authorized to establish
19delayed payment schedules for long-term care providers that
20are unable to make assessment payments when due under this
21Section due to financial difficulties, as determined by the
22Illinois Department. The Illinois Department may not deny a
23request for delay of payment of the assessment imposed under
24this Article if the long-term care provider has not been paid
25by the State or the Medicaid managed care organization for
26services provided during the month on which the assessment is

 

 

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1levied or the Medicaid managed care organization has not been
2paid by the State.
3    (c) If a long-term care provider fails to pay the full
4amount of an assessment payment when due (including any
5extensions granted under subsection (b)), there shall, unless
6waived by the Illinois Department for reasonable cause, be
7added to the assessment imposed by Section 5B-2 a penalty
8assessment equal to the lesser of (i) 5% of the amount of the
9assessment payment not paid on or before the due date plus 5%
10of the portion thereof remaining unpaid on the last day of each
11month thereafter or (ii) 100% of the assessment payment amount
12not paid on or before the due date. For purposes of this
13subsection, payments will be credited first to unpaid
14assessment payment amounts (rather than to penalty or
15interest), beginning with the most delinquent assessment
16payments. Payment cycles of longer than 60 days shall be one
17factor the Director takes into account in granting a waiver
18under this Section.
19    (c-5) If a long-term care facility fails to file its
20assessment bill with payment, there shall, unless waived by
21the Illinois Department for reasonable cause, be added to the
22assessment due a penalty assessment equal to 25% of the
23assessment due. After July 1, 2013, no penalty shall be
24assessed under this Section if the Illinois Department does
25not provide a process for the electronic submission of the
26information required by subsection (a-5).

 

 

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1    (d) Nothing in this amendatory Act of 1993 shall be
2construed to prevent the Illinois Department from collecting
3all amounts due under this Article pursuant to an assessment
4imposed before the effective date of this amendatory Act of
51993.
6    (e) Nothing in this amendatory Act of the 96th General
7Assembly shall be construed to prevent the Illinois Department
8from collecting all amounts due under this Code pursuant to an
9assessment, tax, fee, or penalty imposed before the effective
10date of this amendatory Act of the 96th General Assembly.
11    (f) No installment of the assessment imposed by Section
125B-2 shall be due and payable until after the Department
13notifies the long-term care providers, in writing, that the
14payment methodologies to long-term care providers required
15under Section 5-5.2 5-5.4 of this Code have been approved by
16the Centers for Medicare and Medicaid Services of the U.S.
17Department of Health and Human Services and the waivers under
1842 CFR 433.68 for the assessment imposed by this Section, if
19necessary, have been granted by the Centers for Medicare and
20Medicaid Services of the U.S. Department of Health and Human
21Services. Upon notification to the Department of approval of
22the payment methodologies required under Section 5-5.2 5-5.4
23of this Code and the waivers granted under 42 CFR 433.68, all
24installments otherwise due under Section 5B-4 prior to the
25date of notification shall be due and payable to the
26Department upon written direction from the Department within

 

 

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190 days after issuance by the Comptroller of the payments
2required under Section 5-5.2 5-5.4 of this Code.
3(Source: P.A. 100-501, eff. 6-1-18; 101-649, eff. 7-7-20.)
 
4    (305 ILCS 5/5B-5)  (from Ch. 23, par. 5B-5)
5    Sec. 5B-5. Annual reporting; penalty; maintenance of
6records.
7    (a) After December 31 of each year, and on or before March
831 of the succeeding year, every long-term care provider
9subject to assessment under this Article shall file a report
10with the Illinois Department. The report shall be in a form and
11manner prescribed by the Illinois Department and shall state
12the revenue received by the long-term care provider, reported
13in such categories as may be required by the Illinois
14Department, and other reasonable information the Illinois
15Department requires for the administration of its
16responsibilities under this Code.
17    (b) If a long-term care provider operates or maintains
18more than one long-term care facility in this State, the
19provider may not file a single return covering all those
20long-term care facilities, but shall file a separate return
21for each long-term care facility and shall compute and pay the
22assessment for each long-term care facility separately.
23    (c) Notwithstanding any other provision in this Article,
24in the case of a person who ceases to operate or maintain a
25long-term care facility in respect of which the person is

 

 

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1subject to assessment under this Article as a long-term care
2provider, the person shall file a final, amended return with
3the Illinois Department not more than 90 days after the
4cessation reflecting the adjustment and shall pay with the
5final return the assessment for the year as so adjusted (to the
6extent not previously paid). If a person fails to file a final
7amended return on a timely basis, there shall, unless waived
8by the Illinois Department for reasonable cause, be added to
9the assessment due a penalty assessment equal to 25% of the
10assessment due.
11    (d) Notwithstanding any other provision of this Article, a
12provider who commences operating or maintaining a long-term
13care facility that was under a prior ownership and remained
14licensed by the Department of Public Health shall notify the
15Illinois Department of any the change in ownership regardless
16of percentage, and shall be responsible to immediately pay any
17prior amounts owed by the facility. In addition, beginning
18January 1, 2023, all providers operating or maintaining a
19long-term care facility shall notify the Illinois Department
20of all individual owners and any individuals or organizations
21that are part of a limited liability company with ownership of
22that facility and the percentage ownership of each owner. This
23ownership reporting requirement does not include individual
24shareholders in a publicly held corporation. Submission of the
25information as part of the Department's cost reporting
26requirements shall satisfy this requirement.

 

 

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1    (e) The Department shall develop a procedure for sharing
2with a potential buyer of a facility information regarding
3outstanding assessments and penalties owed by that facility.
4    (f) In the case of a long-term care provider existing as a
5corporation or legal entity other than an individual, the
6return filed by it shall be signed by its president,
7vice-president, secretary, or treasurer or by its properly
8authorized agent.
9    (g) If a long-term care provider fails to file its return
10on or before the due date of the return, there shall, unless
11waived by the Illinois Department for reasonable cause, be
12added to the assessment imposed by Section 5B-2 a penalty
13assessment equal to 25% of the assessment imposed for the
14year. After July 1, 2013, no penalty shall be assessed if the
15Illinois Department has not established a process for the
16electronic submission of information.
17    (h) Every long-term care provider subject to assessment
18under this Article shall keep records and books that will
19permit the determination of occupied bed days on a calendar
20year basis. All such books and records shall be kept in the
21English language and shall, at all times during business hours
22of the day, be subject to inspection by the Illinois
23Department or its duly authorized agents and employees.
24    (i) The Illinois Department shall establish a process for
25long-term care providers to electronically submit all
26information required by this Section no later than July 1,

 

 

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12013.
2(Source: P.A. 96-1530, eff. 2-16-11; 97-403, eff. 1-1-12;
397-813, eff. 7-13-12.)
 
4    (305 ILCS 5/5B-8)  (from Ch. 23, par. 5B-8)
5    Sec. 5B-8. Long-Term Care Provider Fund.
6    (a) There is created in the State Treasury the Long-Term
7Care Provider Fund. Interest earned by the Fund shall be
8credited to the Fund. The Fund shall not be used to replace any
9moneys appropriated to the Medicaid program by the General
10Assembly.
11    (b) The Fund is created for the purpose of receiving and
12disbursing moneys in accordance with this Article.
13Disbursements from the Fund shall be made only as follows:
14        (1) For payments to nursing facilities, including
15    county nursing facilities but excluding State-operated
16    facilities, under Title XIX of the Social Security Act and
17    Article V of this Code.
18        (1.5) For payments to managed care organizations as
19    defined in Section 5-30.1 of this Code.
20        (2) For the reimbursement of moneys collected by the
21    Illinois Department through error or mistake.
22        (3) For payment of administrative expenses incurred by
23    the Illinois Department or its agent in performing the
24    activities authorized by this Article.
25        (3.5) For reimbursement of expenses incurred by

 

 

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1    long-term care facilities, and payment of administrative
2    expenses incurred by the Department of Public Health, in
3    relation to the conduct and analysis of background checks
4    for identified offenders under the Nursing Home Care Act.
5        (4) For payments of any amounts that are reimbursable
6    to the federal government for payments from this Fund that
7    are required to be paid by State warrant.
8        (5) For making transfers to the General Obligation
9    Bond Retirement and Interest Fund, as those transfers are
10    authorized in the proceedings authorizing debt under the
11    Short Term Borrowing Act, but transfers made under this
12    paragraph (5) shall not exceed the principal amount of
13    debt issued in anticipation of the receipt by the State of
14    moneys to be deposited into the Fund.
15        (6) For making transfers, at the direction of the
16    Director of the Governor's Office of Management and Budget
17    during each fiscal year beginning on or after July 1,
18    2011, to other State funds in an annual amount of
19    $20,000,000 of the tax collected pursuant to this Article
20    for the purpose of enforcement of nursing home standards,
21    support of the ombudsman program, and efforts to expand
22    home and community-based services. No transfer under this
23    paragraph shall occur until (i) the payment methodologies
24    created by Public Act 96-1530 under Section 5-5.4 of this
25    Code have been approved by the Centers for Medicare and
26    Medicaid Services of the U.S. Department of Health and

 

 

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1    Human Services and (ii) the assessment imposed by Section
2    5B-2 of this Code is determined to be a permissible tax
3    under Title XIX of the Social Security Act.
4    Disbursements from the Fund, other than transfers made
5pursuant to paragraphs (5) and (6) of this subsection, shall
6be by warrants drawn by the State Comptroller upon receipt of
7vouchers duly executed and certified by the Illinois
8Department.
9    (c) The Fund shall consist of the following:
10        (1) All moneys collected or received by the Illinois
11    Department from the long-term care provider assessment
12    imposed by this Article.
13        (2) All federal matching funds received by the
14    Illinois Department as a result of expenditures made from
15    the Fund by the Illinois Department that are attributable
16    to moneys deposited in the Fund.
17        (3) Any interest or penalty levied in conjunction with
18    the administration of this Article.
19        (4) (Blank).
20        (5) All other monies received for the Fund from any
21    other source, including interest earned thereon.
22(Source: P.A. 96-1530, eff. 2-16-11; 97-584, eff. 8-26-11.)
 
23    (305 ILCS 5/5E-10)
24    Sec. 5E-10. Fee. Through June 30, 2022 or upon federal
25approval by the Centers for Medicare and Medicaid Services of

 

 

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1the long-term care provider assessment described in subsection
2(a-1) of Section 5B-2 of this Code, whichever is later, every
3Every nursing home provider shall pay to the Illinois
4Department, on or before September 10, December 10, March 10,
5and June 10, a fee in the amount of $1.50 for each licensed
6nursing bed day for the calendar quarter in which the payment
7is due. This fee shall not be billed or passed on to any
8resident of a nursing home operated by the nursing home
9provider. All fees received by the Illinois Department under
10this Section shall be deposited into the Long-Term Care
11Provider Fund.
12(Source: P.A. 88-88; 89-21, eff. 7-1-95.)
 
13    (305 ILCS 5/5E-20 new)
14    Sec. 5E-20. Repealer. This Article 5E is repealed on July
151, 2024.
 
16    Section 99. Effective date. This Act takes effect upon
17becoming law.".