Illinois General Assembly - Full Text of HB4846
Illinois General Assembly

Previous General Assemblies

Full Text of HB4846  102nd General Assembly

HB4846sam001 102ND GENERAL ASSEMBLY

Sen. Ann Gillespie

Filed: 11/29/2022

 

 


 

 


 
10200HB4846sam001LRB102 25362 AMQ 41930 a

1
AMENDMENT TO HOUSE BILL 4846

2    AMENDMENT NO. ______. Amend House Bill 4846 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Administrative Procedure Act is
5amended by adding Section 5-45.35 as follows:
 
6    (5 ILCS 100/5-45.35 new)
7    Sec. 5-45.35. Emergency rulemaking; rural emergency
8hospitals. To provide for the expeditious and timely
9implementation of this amendatory Act of the 102nd General
10Assembly, emergency rules implementing the inclusion of rural
11emergency hospitals in the definition of "hospital" in Section
123 of the Hospital Licensing Act may be adopted in accordance
13with Section 5-45 by the Department of Public Health. The
14adoption of emergency rules authorized by Section 5-45 and
15this Section is deemed to be necessary for the public
16interest, safety, and welfare.

 

 

10200HB4846sam001- 2 -LRB102 25362 AMQ 41930 a

1    This Section is repealed one year after the effective date
2of this amendatory Act of the 102nd General Assembly.
 
3    Section 10. The Hospital Licensing Act is amended by
4changing Section 3 as follows:
 
5    (210 ILCS 85/3)
6    Sec. 3. As used in this Act:
7    (A) "Hospital" means any institution, place, building,
8buildings on a campus, or agency, public or private, whether
9organized for profit or not, devoted primarily to the
10maintenance and operation of facilities for the diagnosis and
11treatment or care of 2 or more unrelated persons admitted for
12overnight stay or longer in order to obtain medical, including
13obstetric, psychiatric and nursing, care of illness, disease,
14injury, infirmity, or deformity.
15    The term "hospital", without regard to length of stay,
16shall also include:
17        (a) any facility which is devoted primarily to
18    providing psychiatric and related services and programs
19    for the diagnosis and treatment or care of 2 or more
20    unrelated persons suffering from emotional or nervous
21    diseases;
22        (b) all places where pregnant females are received,
23    cared for, or treated during delivery irrespective of the
24    number of patients received; and .

 

 

10200HB4846sam001- 3 -LRB102 25362 AMQ 41930 a

1        (c) on and after January 1, 2023, a rural emergency
2    hospital, as that term is defined under subsection
3    (kkk)(2) of Section 1861 of the federal Social Security
4    Act; to provide for the expeditious and timely
5    implementation of this amendatory Act of the 102nd General
6    Assembly, emergency rules to implement the changes made to
7    the definition of "hospital" by this amendatory Act of the
8    102nd General Assembly may be adopted by the Department
9    subject to the provisions of Section 5-45 of the Illinois
10    Administrative Procedure Act.
11    The term "hospital" includes general and specialized
12hospitals, tuberculosis sanitaria, mental or psychiatric
13hospitals and sanitaria, and includes maternity homes,
14lying-in homes, and homes for unwed mothers in which care is
15given during delivery.
16    The term "hospital" does not include:
17        (1) any person or institution required to be licensed
18    pursuant to the Nursing Home Care Act, the Specialized
19    Mental Health Rehabilitation Act of 2013, the ID/DD
20    Community Care Act, or the MC/DD Act;
21        (2) hospitalization or care facilities maintained by
22    the State or any department or agency thereof, where such
23    department or agency has authority under law to establish
24    and enforce standards for the hospitalization or care
25    facilities under its management and control;
26        (3) hospitalization or care facilities maintained by

 

 

10200HB4846sam001- 4 -LRB102 25362 AMQ 41930 a

1    the federal government or agencies thereof;
2        (4) hospitalization or care facilities maintained by
3    any university or college established under the laws of
4    this State and supported principally by public funds
5    raised by taxation;
6        (5) any person or facility required to be licensed
7    pursuant to the Substance Use Disorder Act;
8        (6) any facility operated solely by and for persons
9    who rely exclusively upon treatment by spiritual means
10    through prayer, in accordance with the creed or tenets of
11    any well-recognized church or religious denomination;
12        (7) an Alzheimer's disease management center
13    alternative health care model licensed under the
14    Alternative Health Care Delivery Act; or
15        (8) any veterinary hospital or clinic operated by a
16    veterinarian or veterinarians licensed under the
17    Veterinary Medicine and Surgery Practice Act of 2004 or
18    maintained by a State-supported or publicly funded
19    university or college.
20    (B) "Person" means the State, and any political
21subdivision or municipal corporation, individual, firm,
22partnership, corporation, company, association, or joint stock
23association, or the legal successor thereof.
24    (C) "Department" means the Department of Public Health of
25the State of Illinois.
26    (D) "Director" means the Director of Public Health of the

 

 

10200HB4846sam001- 5 -LRB102 25362 AMQ 41930 a

1State of Illinois.
2    (E) "Perinatal" means the period of time between the
3conception of an infant and the end of the first month after
4birth.
5    (F) "Federally designated organ procurement agency" means
6the organ procurement agency designated by the Secretary of
7the U.S. Department of Health and Human Services for the
8service area in which a hospital is located; except that in the
9case of a hospital located in a county adjacent to Wisconsin
10which currently contracts with an organ procurement agency
11located in Wisconsin that is not the organ procurement agency
12designated by the U.S. Secretary of Health and Human Services
13for the service area in which the hospital is located, if the
14hospital applies for a waiver pursuant to 42 U.S.C. USC
151320b-8(a), it may designate an organ procurement agency
16located in Wisconsin to be thereafter deemed its federally
17designated organ procurement agency for the purposes of this
18Act.
19    (G) "Tissue bank" means any facility or program operating
20in Illinois that is certified by the American Association of
21Tissue Banks or the Eye Bank Association of America and is
22involved in procuring, furnishing, donating, or distributing
23corneas, bones, or other human tissue for the purpose of
24injecting, transfusing, or transplanting any of them into the
25human body. "Tissue bank" does not include a licensed blood
26bank. For the purposes of this Act, "tissue" does not include

 

 

10200HB4846sam001- 6 -LRB102 25362 AMQ 41930 a

1organs.
2    (H) "Campus", as this term terms applies to operations,
3has the same meaning as the term "campus" as set forth in
4federal Medicare regulations, 42 CFR 413.65.
5(Source: P.A. 99-180, eff. 7-29-15; 100-759, eff. 1-1-19.)
 
6    Section 15. The Behavior Analyst Licensing Act is amended
7by changing Sections 30, 35, and 150 as follows:
 
8    (225 ILCS 6/30)
9    (Section scheduled to be repealed on January 1, 2028)
10    Sec. 30. Qualifications for behavior analyst license.
11    (a) A person qualifies to be licensed as a behavior
12analyst if that person:
13        (1) has applied in writing or electronically on forms
14    prescribed by the Department;
15        (2) is a graduate of a graduate level program in the
16    field of behavior analysis or a related field with an
17    equivalent course of study in behavior analysis approved
18    by the Department from a regionally accredited university
19    approved by the Department;
20        (3) has completed at least 500 hours of supervision of
21    behavior analysis, as defined by rule;
22        (4) has qualified for and passed the examination for
23    the practice of behavior analysis as authorized by the
24    Department; and

 

 

10200HB4846sam001- 7 -LRB102 25362 AMQ 41930 a

1        (5) has paid the required fees.
2    (b) The Department may issue a license to a certified
3behavior analyst seeking licensure as a licensed behavior
4analyst who (i) does not have the supervised experience as
5described in paragraph (3) of subsection (a), (ii) applies for
6licensure before July 1, 2028, and (iii) has completed all of
7the following:
8        (1) has applied in writing or electronically on forms
9    prescribed by the Department;
10        (2) is a graduate of a graduate level program in the
11    field of behavior analysis from a regionally accredited
12    university approved by the Department;
13        (3) submits evidence of certification by an
14    appropriate national certifying body as determined by rule
15    of the Department;
16        (4) has passed the examination for the practice of
17    behavior analysis as authorized by the Department; and
18        (5) has paid the required fees.
19    (c) An applicant has 3 years after the date of application
20to complete the application process. If the process has not
21been completed in 3 years, the application shall be denied,
22the fee shall be forfeited, and the applicant must reapply and
23meet the requirements in effect at the time of reapplication.
24    (d) Each applicant for licensure as a an behavior analyst
25shall have his or her fingerprints submitted to the Illinois
26State Police in an electronic format that complies with the

 

 

10200HB4846sam001- 8 -LRB102 25362 AMQ 41930 a

1form and manner for requesting and furnishing criminal history
2record information as prescribed by the Illinois State Police.
3These fingerprints shall be transmitted through a live scan
4fingerprint vendor licensed by the Department. These
5fingerprints shall be checked against the Illinois State
6Police and Federal Bureau of Investigation criminal history
7record databases now and hereafter filed, including, but not
8limited to, civil, criminal, and latent fingerprint databases.
9The Illinois State Police shall charge a fee for conducting
10the criminal history records check, which shall be deposited
11in the State Police Services Fund and shall not exceed the
12actual cost of the records check. The Illinois State Police
13shall furnish, pursuant to positive identification, records of
14Illinois convictions as prescribed under the Illinois Uniform
15Conviction Information Act and shall forward the national
16criminal history record information to the Department.
17(Source: P.A. 102-953, eff. 5-27-22; revised 8-19-22.)
 
18    (225 ILCS 6/35)
19    (Section scheduled to be repealed on January 1, 2028)
20    Sec. 35. Qualifications for assistant behavior analyst
21license.
22    (a) A person qualifies to be licensed as an assistant
23behavior analyst if that person:
24        (1) has applied in writing or electronically on forms
25    prescribed by the Department;

 

 

10200HB4846sam001- 9 -LRB102 25362 AMQ 41930 a

1        (2) is a graduate of a bachelor's level program in the
2    field of behavior analysis or a related field with an
3    equivalent course of study in behavior analysis approved
4    by the Department from a regionally accredited university
5    approved by the Department;
6        (3) has met the supervised work experience;
7        (4) has qualified for and passed the examination for
8    the practice of behavior analysis as a licensed assistant
9    behavior analyst as authorized by the Department; and
10        (5) has paid the required fees.
11    (b) The Department may issue a license to a certified
12assistant behavior analyst seeking licensure as a licensed
13assistant behavior analyst who (i) does not have the
14supervised experience as described in paragraph (3) of
15subsection (a), (ii) applies for licensure before July 1,
162028, and (iii) has completed all of the following:
17        (1) has applied in writing or electronically on forms
18    prescribed by the Department;
19        (2) is a graduate of a bachelor's bachelors level
20    program in the field of behavior analysis;
21        (3) submits evidence of certification by an
22    appropriate national certifying body as determined by rule
23    of the Department;
24        (4) has passed the examination for the practice of
25    behavior analysis as authorized by the Department; and
26        (5) has paid the required fees.

 

 

10200HB4846sam001- 10 -LRB102 25362 AMQ 41930 a

1    (c) An applicant has 3 years after the date of application
2to complete the application process. If the process has not
3been completed in 3 years, the application shall be denied,
4the fee shall be forfeited, and the applicant must reapply and
5meet the requirements in effect at the time of reapplication.
6    (d) Each applicant for licensure as an assistant behavior
7analyst shall have his or her fingerprints submitted to the
8Illinois State Police in an electronic format that complies
9with the form and manner for requesting and furnishing
10criminal history record information as prescribed by the
11Illinois State Police. These fingerprints shall be transmitted
12through a live scan fingerprint vendor licensed by the
13Department. These fingerprints shall be checked against the
14Illinois State Police and Federal Bureau of Investigation
15criminal history record databases now and hereafter filed,
16including, but not limited to, civil, criminal, and latent
17fingerprint databases. The Illinois State Police shall charge
18a fee for conducting the criminal history records check, which
19shall be deposited in the State Police Services Fund and shall
20not exceed the actual cost of the records check. The Illinois
21State Police shall furnish, pursuant to positive
22identification, records of Illinois convictions as prescribed
23under the Illinois Uniform Conviction Information Act and
24shall forward the national criminal history record information
25to the Department.
26(Source: P.A. 102-953, eff. 5-27-22; revised 8-19-22.)
 

 

 

10200HB4846sam001- 11 -LRB102 25362 AMQ 41930 a

1    (225 ILCS 6/150)
2    (Section scheduled to be repealed on January 1, 2028)
3    Sec. 150. License restrictions and limitations.
4Notwithstanding the exclusion in paragraph (2) of subsection
5(c) of Section 20 that permits an individual to implement a
6behavior analytic treatment plan under the extended authority,
7direction, and supervision of a licensed behavior analyst or
8licensed assistant behavior analyst, no No business
9organization shall provide, attempt to provide, or offer to
10provide behavior analysis services unless every member,
11partner, shareholder, director, officer, holder of any other
12ownership interest, agent, and employee who renders applied
13behavior analysis services holds a currently valid license
14issued under this Act. No business shall be created that (i)
15has a stated purpose that includes behavior analysis, or (ii)
16practices or holds itself out as available to practice
17behavior analysis therapy, unless it is organized under the
18Professional Service Corporation Act or Professional Limited
19Liability Company Act. Nothing in this Act shall preclude
20individuals licensed under this Act from practicing directly
21or indirectly for a physician licensed to practice medicine in
22all its branches under the Medical Practice Act of 1987 or for
23any legal entity as provided under subsection (c) of Section
2422.2 of the Medical Practice Act of 1987.
25(Source: P.A. 102-953, eff. 5-27-22.)
 

 

 

10200HB4846sam001- 12 -LRB102 25362 AMQ 41930 a

1    Section 20. The Podiatric Medical Practice Act of 1987 is
2amended by adding Section 18.1 as follows:
 
3    (225 ILCS 100/18.1 new)
4    Sec. 18.1. Fee waivers. Notwithstanding any provision of
5law to the contrary, during State Fiscal Year 2023, the
6Department shall allow individuals a one-time waiver of fees
7imposed under Section 18 of this Act. No individual may
8benefit from such a waiver more than once. If an individual has
9already paid a fee required under Section 18 for Fiscal Year
102023, then the Department shall apply the money paid for that
11fee as a credit to the next required fee.
 
12    Section 25. The Illinois Public Aid Code is amended by
13changing Sections 5-5.02, 5-5.2, 5-5.7b, and 5B-2 as follows:
 
14    (305 ILCS 5/5-5.02)  (from Ch. 23, par. 5-5.02)
15    Sec. 5-5.02. Hospital reimbursements.
16    (a) Reimbursement to hospitals; July 1, 1992 through
17September 30, 1992. Notwithstanding any other provisions of
18this Code or the Illinois Department's Rules promulgated under
19the Illinois Administrative Procedure Act, reimbursement to
20hospitals for services provided during the period July 1, 1992
21through September 30, 1992, shall be as follows:
22        (1) For inpatient hospital services rendered, or if

 

 

10200HB4846sam001- 13 -LRB102 25362 AMQ 41930 a

1    applicable, for inpatient hospital discharges occurring,
2    on or after July 1, 1992 and on or before September 30,
3    1992, the Illinois Department shall reimburse hospitals
4    for inpatient services under the reimbursement
5    methodologies in effect for each hospital, and at the
6    inpatient payment rate calculated for each hospital, as of
7    June 30, 1992. For purposes of this paragraph,
8    "reimbursement methodologies" means all reimbursement
9    methodologies that pertain to the provision of inpatient
10    hospital services, including, but not limited to, any
11    adjustments for disproportionate share, targeted access,
12    critical care access and uncompensated care, as defined by
13    the Illinois Department on June 30, 1992.
14        (2) For the purpose of calculating the inpatient
15    payment rate for each hospital eligible to receive
16    quarterly adjustment payments for targeted access and
17    critical care, as defined by the Illinois Department on
18    June 30, 1992, the adjustment payment for the period July
19    1, 1992 through September 30, 1992, shall be 25% of the
20    annual adjustment payments calculated for each eligible
21    hospital, as of June 30, 1992. The Illinois Department
22    shall determine by rule the adjustment payments for
23    targeted access and critical care beginning October 1,
24    1992.
25        (3) For the purpose of calculating the inpatient
26    payment rate for each hospital eligible to receive

 

 

10200HB4846sam001- 14 -LRB102 25362 AMQ 41930 a

1    quarterly adjustment payments for uncompensated care, as
2    defined by the Illinois Department on June 30, 1992, the
3    adjustment payment for the period August 1, 1992 through
4    September 30, 1992, shall be one-sixth of the total
5    uncompensated care adjustment payments calculated for each
6    eligible hospital for the uncompensated care rate year, as
7    defined by the Illinois Department, ending on July 31,
8    1992. The Illinois Department shall determine by rule the
9    adjustment payments for uncompensated care beginning
10    October 1, 1992.
11    (b) Inpatient payments. For inpatient services provided on
12or after October 1, 1993, in addition to rates paid for
13hospital inpatient services pursuant to the Illinois Health
14Finance Reform Act, as now or hereafter amended, or the
15Illinois Department's prospective reimbursement methodology,
16or any other methodology used by the Illinois Department for
17inpatient services, the Illinois Department shall make
18adjustment payments, in an amount calculated pursuant to the
19methodology described in paragraph (c) of this Section, to
20hospitals that the Illinois Department determines satisfy any
21one of the following requirements:
22        (1) Hospitals that are described in Section 1923 of
23    the federal Social Security Act, as now or hereafter
24    amended, except that for rate year 2015 and after a
25    hospital described in Section 1923(b)(1)(B) of the federal
26    Social Security Act and qualified for the payments

 

 

10200HB4846sam001- 15 -LRB102 25362 AMQ 41930 a

1    described in subsection (c) of this Section for rate year
2    2014 provided the hospital continues to meet the
3    description in Section 1923(b)(1)(B) in the current
4    determination year; or
5        (2) Illinois hospitals that have a Medicaid inpatient
6    utilization rate which is at least one-half a standard
7    deviation above the mean Medicaid inpatient utilization
8    rate for all hospitals in Illinois receiving Medicaid
9    payments from the Illinois Department; or
10        (3) Illinois hospitals that on July 1, 1991 had a
11    Medicaid inpatient utilization rate, as defined in
12    paragraph (h) of this Section, that was at least the mean
13    Medicaid inpatient utilization rate for all hospitals in
14    Illinois receiving Medicaid payments from the Illinois
15    Department and which were located in a planning area with
16    one-third or fewer excess beds as determined by the Health
17    Facilities and Services Review Board, and that, as of June
18    30, 1992, were located in a federally designated Health
19    Manpower Shortage Area; or
20        (4) Illinois hospitals that:
21            (A) have a Medicaid inpatient utilization rate
22        that is at least equal to the mean Medicaid inpatient
23        utilization rate for all hospitals in Illinois
24        receiving Medicaid payments from the Department; and
25            (B) also have a Medicaid obstetrical inpatient
26        utilization rate that is at least one standard

 

 

10200HB4846sam001- 16 -LRB102 25362 AMQ 41930 a

1        deviation above the mean Medicaid obstetrical
2        inpatient utilization rate for all hospitals in
3        Illinois receiving Medicaid payments from the
4        Department for obstetrical services; or
5        (5) Any children's hospital, which means a hospital
6    devoted exclusively to caring for children. A hospital
7    which includes a facility devoted exclusively to caring
8    for children shall be considered a children's hospital to
9    the degree that the hospital's Medicaid care is provided
10    to children if either (i) the facility devoted exclusively
11    to caring for children is separately licensed as a
12    hospital by a municipality prior to February 28, 2013;
13    (ii) the hospital has been designated by the State as a
14    Level III perinatal care facility, has a Medicaid
15    Inpatient Utilization rate greater than 55% for the rate
16    year 2003 disproportionate share determination, and has
17    more than 10,000 qualified children days as defined by the
18    Department in rulemaking; (iii) the hospital has been
19    designated as a Perinatal Level III center by the State as
20    of December 1, 2017, is a Pediatric Critical Care Center
21    designated by the State as of December 1, 2017 and has a
22    2017 Medicaid inpatient utilization rate equal to or
23    greater than 45%; or (iv) the hospital has been designated
24    as a Perinatal Level II center by the State as of December
25    1, 2017, has a 2017 Medicaid Inpatient Utilization Rate
26    greater than 70%, and has at least 10 pediatric beds as

 

 

10200HB4846sam001- 17 -LRB102 25362 AMQ 41930 a

1    listed on the IDPH 2015 calendar year hospital profile; or
2        (6) A hospital that reopens a previously closed
3    hospital facility within 4 calendar years of the hospital
4    facility's closure, if the previously closed hospital
5    facility qualified for payments under paragraph (c) at the
6    time of closure, until utilization data for the new
7    facility is available for the Medicaid inpatient
8    utilization rate calculation. For purposes of this clause,
9    a "closed hospital facility" shall include hospitals that
10    have been terminated from participation in the medical
11    assistance program in accordance with Section 12-4.25 of
12    this Code.
13    (c) Inpatient adjustment payments. The adjustment payments
14required by paragraph (b) shall be calculated based upon the
15hospital's Medicaid inpatient utilization rate as follows:
16        (1) hospitals with a Medicaid inpatient utilization
17    rate below the mean shall receive a per day adjustment
18    payment equal to $25;
19        (2) hospitals with a Medicaid inpatient utilization
20    rate that is equal to or greater than the mean Medicaid
21    inpatient utilization rate but less than one standard
22    deviation above the mean Medicaid inpatient utilization
23    rate shall receive a per day adjustment payment equal to
24    the sum of $25 plus $1 for each one percent that the
25    hospital's Medicaid inpatient utilization rate exceeds the
26    mean Medicaid inpatient utilization rate;

 

 

10200HB4846sam001- 18 -LRB102 25362 AMQ 41930 a

1        (3) hospitals with a Medicaid inpatient utilization
2    rate that is equal to or greater than one standard
3    deviation above the mean Medicaid inpatient utilization
4    rate but less than 1.5 standard deviations above the mean
5    Medicaid inpatient utilization rate shall receive a per
6    day adjustment payment equal to the sum of $40 plus $7 for
7    each one percent that the hospital's Medicaid inpatient
8    utilization rate exceeds one standard deviation above the
9    mean Medicaid inpatient utilization rate;
10        (4) hospitals with a Medicaid inpatient utilization
11    rate that is equal to or greater than 1.5 standard
12    deviations above the mean Medicaid inpatient utilization
13    rate shall receive a per day adjustment payment equal to
14    the sum of $90 plus $2 for each one percent that the
15    hospital's Medicaid inpatient utilization rate exceeds 1.5
16    standard deviations above the mean Medicaid inpatient
17    utilization rate; and
18        (5) hospitals qualifying under clause (6) of paragraph
19    (b) shall have the rate assigned to the previously closed
20    hospital facility at the date of closure, until
21    utilization data for the new facility is available for the
22    Medicaid inpatient utilization rate calculation.
23    (c-1) Effective October 1, 2023, for rate year 2024 and
24thereafter, the Medicaid Inpatient utilization rate, as
25defined in paragraph (1) of subsection (h) and used in the
26determination of eligibility for payments under paragraph (c),

 

 

10200HB4846sam001- 19 -LRB102 25362 AMQ 41930 a

1shall be modified to exclude from both the numerator and
2denominator all days of care provided to military recruits or
3trainees for the United States Navy and covered by TriCare or
4its successor.
5    (d) Supplemental adjustment payments. In addition to the
6adjustment payments described in paragraph (c), hospitals as
7defined in clauses (1) through (6) of paragraph (b), excluding
8county hospitals (as defined in subsection (c) of Section 15-1
9of this Code) and a hospital organized under the University of
10Illinois Hospital Act, shall be paid supplemental inpatient
11adjustment payments of $60 per day. For purposes of Title XIX
12of the federal Social Security Act, these supplemental
13adjustment payments shall not be classified as adjustment
14payments to disproportionate share hospitals.
15    (e) The inpatient adjustment payments described in
16paragraphs (c) and (d) shall be increased on October 1, 1993
17and annually thereafter by a percentage equal to the lesser of
18(i) the increase in the DRI hospital cost index for the most
19recent 12-month 12 month period for which data are available,
20or (ii) the percentage increase in the statewide average
21hospital payment rate over the previous year's statewide
22average hospital payment rate. The sum of the inpatient
23adjustment payments under paragraphs (c) and (d) to a
24hospital, other than a county hospital (as defined in
25subsection (c) of Section 15-1 of this Code) or a hospital
26organized under the University of Illinois Hospital Act,

 

 

10200HB4846sam001- 20 -LRB102 25362 AMQ 41930 a

1however, shall not exceed $275 per day; that limit shall be
2increased on October 1, 1993 and annually thereafter by a
3percentage equal to the lesser of (i) the increase in the DRI
4hospital cost index for the most recent 12-month period for
5which data are available or (ii) the percentage increase in
6the statewide average hospital payment rate over the previous
7year's statewide average hospital payment rate.
8    (f) Children's hospital inpatient adjustment payments. For
9children's hospitals, as defined in clause (5) of paragraph
10(b), the adjustment payments required pursuant to paragraphs
11(c) and (d) shall be multiplied by 2.0.
12    (g) County hospital inpatient adjustment payments. For
13county hospitals, as defined in subsection (c) of Section 15-1
14of this Code, there shall be an adjustment payment as
15determined by rules issued by the Illinois Department.
16    (h) For the purposes of this Section the following terms
17shall be defined as follows:
18        (1) "Medicaid inpatient utilization rate" means a
19    fraction, the numerator of which is the number of a
20    hospital's inpatient days provided in a given 12-month
21    period to patients who, for such days, were eligible for
22    Medicaid under Title XIX of the federal Social Security
23    Act, and the denominator of which is the total number of
24    the hospital's inpatient days in that same period.
25        (2) "Mean Medicaid inpatient utilization rate" means
26    the total number of Medicaid inpatient days provided by

 

 

10200HB4846sam001- 21 -LRB102 25362 AMQ 41930 a

1    all Illinois Medicaid-participating hospitals divided by
2    the total number of inpatient days provided by those same
3    hospitals.
4        (3) "Medicaid obstetrical inpatient utilization rate"
5    means the ratio of Medicaid obstetrical inpatient days to
6    total Medicaid inpatient days for all Illinois hospitals
7    receiving Medicaid payments from the Illinois Department.
8    (i) Inpatient adjustment payment limit. In order to meet
9the limits of Public Law 102-234 and Public Law 103-66, the
10Illinois Department shall by rule adjust disproportionate
11share adjustment payments.
12    (j) University of Illinois Hospital inpatient adjustment
13payments. For hospitals organized under the University of
14Illinois Hospital Act, there shall be an adjustment payment as
15determined by rules adopted by the Illinois Department.
16    (k) The Illinois Department may by rule establish criteria
17for and develop methodologies for adjustment payments to
18hospitals participating under this Article.
19    (l) On and after July 1, 2012, the Department shall reduce
20any rate of reimbursement for services or other payments or
21alter any methodologies authorized by this Code to reduce any
22rate of reimbursement for services or other payments in
23accordance with Section 5-5e.
24    (m) The Department shall establish a cost-based
25reimbursement methodology for determining payments to
26hospitals for approved graduate medical education (GME)

 

 

10200HB4846sam001- 22 -LRB102 25362 AMQ 41930 a

1programs for dates of service on and after July 1, 2018.
2        (1) As used in this subsection, "hospitals" means the
3    University of Illinois Hospital as defined in the
4    University of Illinois Hospital Act and a county hospital
5    in a county of over 3,000,000 inhabitants.
6        (2) An amendment to the Illinois Title XIX State Plan
7    defining GME shall maximize reimbursement, shall not be
8    limited to the education programs or special patient care
9    payments allowed under Medicare, and shall include:
10            (A) inpatient days;
11            (B) outpatient days;
12            (C) direct costs;
13            (D) indirect costs;
14            (E) managed care days;
15            (F) all stages of medical training and education
16        including students, interns, residents, and fellows
17        with no caps on the number of persons who may qualify;
18        and
19            (G) patient care payments related to the
20        complexities of treating Medicaid enrollees including
21        clinical and social determinants of health.
22        (3) The Department shall make all GME payments
23    directly to hospitals including such costs in support of
24    clients enrolled in Medicaid managed care entities.
25        (4) The Department shall promptly take all actions
26    necessary for reimbursement to be effective for dates of

 

 

10200HB4846sam001- 23 -LRB102 25362 AMQ 41930 a

1    service on and after July 1, 2018 including publishing all
2    appropriate public notices, amendments to the Illinois
3    Title XIX State Plan, and adoption of administrative rules
4    if necessary.
5        (5) As used in this subsection, "managed care days"
6    means costs associated with services rendered to enrollees
7    of Medicaid managed care entities. "Medicaid managed care
8    entities" means any entity which contracts with the
9    Department to provide services paid for on a capitated
10    basis. "Medicaid managed care entities" includes a managed
11    care organization and a managed care community network.
12        (6) All payments under this Section are contingent
13    upon federal approval of changes to the Illinois Title XIX
14    State Plan, if that approval is required.
15        (7) The Department may adopt rules necessary to
16    implement Public Act 100-581 through the use of emergency
17    rulemaking in accordance with subsection (aa) of Section
18    5-45 of the Illinois Administrative Procedure Act. For
19    purposes of that Act, the General Assembly finds that the
20    adoption of rules to implement Public Act 100-581 is
21    deemed an emergency and necessary for the public interest,
22    safety, and welfare.
23(Source: P.A. 101-81, eff. 7-12-19; 102-682, eff. 12-10-21;
24102-886, eff. 5-17-22.)
 
25    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)

 

 

10200HB4846sam001- 24 -LRB102 25362 AMQ 41930 a

1    Sec. 5-5.2. Payment.
2    (a) All nursing facilities that are grouped pursuant to
3Section 5-5.1 of this Act shall receive the same rate of
4payment for similar services.
5    (b) It shall be a matter of State policy that the Illinois
6Department shall utilize a uniform billing cycle throughout
7the State for the long-term care providers.
8    (c) (Blank).
9    (c-1) Notwithstanding any other provisions of this Code,
10the methodologies for reimbursement of nursing services as
11provided under this Article shall no longer be applicable for
12bills payable for nursing services rendered on or after a new
13reimbursement system based on the Patient Driven Payment Model
14(PDPM) has been fully operationalized, which shall take effect
15for services provided on or after the implementation of the
16PDPM reimbursement system begins. For the purposes of this
17amendatory Act of the 102nd General Assembly, the
18implementation date of the PDPM reimbursement system and all
19related provisions shall be July 1, 2022 if the following
20conditions are met: (i) the Centers for Medicare and Medicaid
21Services has approved corresponding changes in the
22reimbursement system and bed assessment; and (ii) the
23Department has filed rules to implement these changes no later
24than June 1, 2022. Failure of the Department to file rules to
25implement the changes provided in this amendatory Act of the
26102nd General Assembly no later than June 1, 2022 shall result

 

 

10200HB4846sam001- 25 -LRB102 25362 AMQ 41930 a

1in the implementation date being delayed to October 1, 2022.
2    (d) The new nursing services reimbursement methodology
3utilizing the Patient Driven Payment Model, which shall be
4referred to as the PDPM reimbursement system, taking effect
5July 1, 2022, upon federal approval by the Centers for
6Medicare and Medicaid Services, shall be based on the
7following:
8        (1) The methodology shall be resident-centered,
9    facility-specific, cost-based, and based on guidance from
10    the Centers for Medicare and Medicaid Services.
11        (2) Costs shall be annually rebased and case mix index
12    quarterly updated. The nursing services methodology will
13    be assigned to the Medicaid enrolled residents on record
14    as of 30 days prior to the beginning of the rate period in
15    the Department's Medicaid Management Information System
16    (MMIS) as present on the last day of the second quarter
17    preceding the rate period based upon the Assessment
18    Reference Date of the Minimum Data Set (MDS).
19        (3) Regional wage adjustors based on the Health
20    Service Areas (HSA) groupings and adjusters in effect on
21    April 30, 2012 shall be included, except no adjuster shall
22    be lower than 1.06.
23        (4) PDPM nursing case mix indices in effect on March
24    1, 2022 shall be assigned to each resident class at no less
25    than 0.7858 of the Centers for Medicare and Medicaid
26    Services PDPM unadjusted case mix values, in effect on

 

 

10200HB4846sam001- 26 -LRB102 25362 AMQ 41930 a

1    March 1, 2022, utilizing an index maximization approach.
2        (5) The pool of funds available for distribution by
3    case mix and the base facility rate shall be determined
4    using the formula contained in subsection (d-1).
5        (6) The Department shall establish a variable per diem
6    staffing add-on in accordance with the most recent
7    available federal staffing report, currently the Payroll
8    Based Journal, for the same period of time, and if
9    applicable adjusted for acuity using the same quarter's
10    MDS. The Department shall rely on Payroll Based Journals
11    provided to the Department of Public Health to make a
12    determination of non-submission. If the Department is
13    notified by a facility of missing or inaccurate Payroll
14    Based Journal data or an incorrect calculation of
15    staffing, the Department must make a correction as soon as
16    the error is verified for the applicable quarter.
17        Facilities with at least 70% of the staffing indicated
18    by the STRIVE study shall be paid a per diem add-on of $9,
19    increasing by equivalent steps for each whole percentage
20    point until the facilities reach a per diem of $14.88.
21    Facilities with at least 80% of the staffing indicated by
22    the STRIVE study shall be paid a per diem add-on of $14.88,
23    increasing by equivalent steps for each whole percentage
24    point until the facilities reach a per diem add-on of
25    $23.80. Facilities with at least 92% of the staffing
26    indicated by the STRIVE study shall be paid a per diem

 

 

10200HB4846sam001- 27 -LRB102 25362 AMQ 41930 a

1    add-on of $23.80, increasing by equivalent steps for each
2    whole percentage point until the facilities reach a per
3    diem add-on of $29.75. Facilities with at least 100% of
4    the staffing indicated by the STRIVE study shall be paid a
5    per diem add-on of $29.75, increasing by equivalent steps
6    for each whole percentage point until the facilities reach
7    a per diem add-on of $35.70. Facilities with at least 110%
8    of the staffing indicated by the STRIVE study shall be
9    paid a per diem add-on of $35.70, increasing by equivalent
10    steps for each whole percentage point until the facilities
11    reach a per diem add-on of $38.68. Facilities with at
12    least 125% or higher of the staffing indicated by the
13    STRIVE study shall be paid a per diem add-on of $38.68.
14    Beginning April 1, 2023, no nursing facility's variable
15    staffing per diem add-on shall be reduced by more than 5%
16    in 2 consecutive quarters. For the quarters beginning July
17    1, 2022 and October 1, 2022, no facility's variable per
18    diem staffing add-on shall be calculated at a rate lower
19    than 85% of the staffing indicated by the STRIVE study. No
20    facility below 70% of the staffing indicated by the STRIVE
21    study shall receive a variable per diem staffing add-on
22    after December 31, 2022.
23        (7) For dates of services beginning July 1, 2022, the
24    PDPM nursing component per diem for each nursing facility
25    shall be the product of the facility's (i) statewide PDPM
26    nursing base per diem rate, $92.25, adjusted for the

 

 

10200HB4846sam001- 28 -LRB102 25362 AMQ 41930 a

1    facility average PDPM case mix index calculated quarterly
2    and (ii) the regional wage adjuster, and then add the
3    Medicaid access adjustment as defined in (e-3) of this
4    Section. Transition rates for services provided between
5    July 1, 2022 and October 1, 2023 shall be the greater of
6    the PDPM nursing component per diem or:
7            (A) for the quarter beginning July 1, 2022, the
8        RUG-IV nursing component per diem;
9            (B) for the quarter beginning October 1, 2022, the
10        sum of the RUG-IV nursing component per diem
11        multiplied by 0.80 and the PDPM nursing component per
12        diem multiplied by 0.20;
13            (C) for the quarter beginning January 1, 2023, the
14        sum of the RUG-IV nursing component per diem
15        multiplied by 0.60 and the PDPM nursing component per
16        diem multiplied by 0.40;
17            (D) for the quarter beginning April 1, 2023, the
18        sum of the RUG-IV nursing component per diem
19        multiplied by 0.40 and the PDPM nursing component per
20        diem multiplied by 0.60;
21            (E) for the quarter beginning July 1, 2023, the
22        sum of the RUG-IV nursing component per diem
23        multiplied by 0.20 and the PDPM nursing component per
24        diem multiplied by 0.80; or
25            (F) for the quarter beginning October 1, 2023 and
26        each subsequent quarter, the transition rate shall end

 

 

10200HB4846sam001- 29 -LRB102 25362 AMQ 41930 a

1        and a nursing facility shall be paid 100% of the PDPM
2        nursing component per diem.
3    (d-1) Calculation of base year Statewide RUG-IV nursing
4base per diem rate.
5        (1) Base rate spending pool shall be:
6            (A) The base year resident days which are
7        calculated by multiplying the number of Medicaid
8        residents in each nursing home as indicated in the MDS
9        data defined in paragraph (4) by 365.
10            (B) Each facility's nursing component per diem in
11        effect on July 1, 2012 shall be multiplied by
12        subsection (A).
13            (C) Thirteen million is added to the product of
14        subparagraph (A) and subparagraph (B) to adjust for
15        the exclusion of nursing homes defined in paragraph
16        (5).
17        (2) For each nursing home with Medicaid residents as
18    indicated by the MDS data defined in paragraph (4),
19    weighted days adjusted for case mix and regional wage
20    adjustment shall be calculated. For each home this
21    calculation is the product of:
22            (A) Base year resident days as calculated in
23        subparagraph (A) of paragraph (1).
24            (B) The nursing home's regional wage adjustor
25        based on the Health Service Areas (HSA) groupings and
26        adjustors in effect on April 30, 2012.

 

 

10200HB4846sam001- 30 -LRB102 25362 AMQ 41930 a

1            (C) Facility weighted case mix which is the number
2        of Medicaid residents as indicated by the MDS data
3        defined in paragraph (4) multiplied by the associated
4        case weight for the RUG-IV 48 grouper model using
5        standard RUG-IV procedures for index maximization.
6            (D) The sum of the products calculated for each
7        nursing home in subparagraphs (A) through (C) above
8        shall be the base year case mix, rate adjusted
9        weighted days.
10        (3) The Statewide RUG-IV nursing base per diem rate:
11            (A) on January 1, 2014 shall be the quotient of the
12        paragraph (1) divided by the sum calculated under
13        subparagraph (D) of paragraph (2);
14            (B) on and after July 1, 2014 and until July 1,
15        2022, shall be the amount calculated under
16        subparagraph (A) of this paragraph (3) plus $1.76; and
17            (C) beginning July 1, 2022 and thereafter, $7
18        shall be added to the amount calculated under
19        subparagraph (B) of this paragraph (3) of this
20        Section.
21        (4) Minimum Data Set (MDS) comprehensive assessments
22    for Medicaid residents on the last day of the quarter used
23    to establish the base rate.
24        (5) Nursing facilities designated as of July 1, 2012
25    by the Department as "Institutions for Mental Disease"
26    shall be excluded from all calculations under this

 

 

10200HB4846sam001- 31 -LRB102 25362 AMQ 41930 a

1    subsection. The data from these facilities shall not be
2    used in the computations described in paragraphs (1)
3    through (4) above to establish the base rate.
4    (e) Beginning July 1, 2014, the Department shall allocate
5funding in the amount up to $10,000,000 for per diem add-ons to
6the RUGS methodology for dates of service on and after July 1,
72014:
8        (1) $0.63 for each resident who scores in I4200
9    Alzheimer's Disease or I4800 non-Alzheimer's Dementia.
10        (2) $2.67 for each resident who scores either a "1" or
11    "2" in any items S1200A through S1200I and also scores in
12    RUG groups PA1, PA2, BA1, or BA2 until September 30, 2023,
13    or for each resident who scores a "1" or "2" in PDPM groups
14    PA1, PA2, BAB1, or BAB2 beginning July 1, 2022 and
15    thereafter.
16    (e-1) (Blank).
17    (e-2) For dates of services beginning January 1, 2014 and
18ending September 30, 2023, the RUG-IV nursing component per
19diem for a nursing home shall be the product of the statewide
20RUG-IV nursing base per diem rate, the facility average case
21mix index, and the regional wage adjustor.
22    (e-3) A Medicaid Access Adjustment of $4 adjusted for the
23facility average PDPM case mix index calculated quarterly
24shall be added to the statewide PDPM nursing per diem for all
25facilities with annual Medicaid bed days of at least 70% of all
26occupied bed days adjusted quarterly. For each new calendar

 

 

10200HB4846sam001- 32 -LRB102 25362 AMQ 41930 a

1year and for the 6-month period beginning July 1, 2022, the
2percentage of a facility's occupied bed days comprised of
3Medicaid bed days shall be determined by the Department
4quarterly. Beginning on the effective date of this amendatory
5Act of the 102nd General Assembly, the Medicaid Access
6Adjustment of $4 shall be increased by $0.75 and the increased
7reimbursement rate shall be applied to services rendered on
8and after July 1, 2022. The Department shall recalculate each
9affected facility's reimbursement rate retroactive to July 1,
102022 and remit all additional money owed to each facility as a
11result of the retroactive recalculation. This subsection shall
12be inoperative on and after January 1, 2028.
13    (f) (Blank).
14    (g) Notwithstanding any other provision of this Code, on
15and after July 1, 2012, for facilities not designated by the
16Department of Healthcare and Family Services as "Institutions
17for Mental Disease", rates effective May 1, 2011 shall be
18adjusted as follows:
19        (1) (Blank);
20        (2) (Blank);
21        (3) Facility rates for the capital and support
22    components shall be reduced by 1.7%.
23    (h) Notwithstanding any other provision of this Code, on
24and after July 1, 2012, nursing facilities designated by the
25Department of Healthcare and Family Services as "Institutions
26for Mental Disease" and "Institutions for Mental Disease" that

 

 

10200HB4846sam001- 33 -LRB102 25362 AMQ 41930 a

1are facilities licensed under the Specialized Mental Health
2Rehabilitation Act of 2013 shall have the nursing,
3socio-developmental, capital, and support components of their
4reimbursement rate effective May 1, 2011 reduced in total by
52.7%.
6    (i) On and after July 1, 2014, the reimbursement rates for
7the support component of the nursing facility rate for
8facilities licensed under the Nursing Home Care Act as skilled
9or intermediate care facilities shall be the rate in effect on
10June 30, 2014 increased by 8.17%.
11    (j) Notwithstanding any other provision of law, subject to
12federal approval, effective July 1, 2019, sufficient funds
13shall be allocated for changes to rates for facilities
14licensed under the Nursing Home Care Act as skilled nursing
15facilities or intermediate care facilities for dates of
16services on and after July 1, 2019: (i) to establish, through
17June 30, 2022 a per diem add-on to the direct care per diem
18rate not to exceed $70,000,000 annually in the aggregate
19taking into account federal matching funds for the purpose of
20addressing the facility's unique staffing needs, adjusted
21quarterly and distributed by a weighted formula based on
22Medicaid bed days on the last day of the second quarter
23preceding the quarter for which the rate is being adjusted.
24Beginning July 1, 2022, the annual $70,000,000 described in
25the preceding sentence shall be dedicated to the variable per
26diem add-on for staffing under paragraph (6) of subsection

 

 

10200HB4846sam001- 34 -LRB102 25362 AMQ 41930 a

1(d); and (ii) in an amount not to exceed $170,000,000 annually
2in the aggregate taking into account federal matching funds to
3permit the support component of the nursing facility rate to
4be updated as follows:
5        (1) 80%, or $136,000,000, of the funds shall be used
6    to update each facility's rate in effect on June 30, 2019
7    using the most recent cost reports on file, which have had
8    a limited review conducted by the Department of Healthcare
9    and Family Services and will not hold up enacting the rate
10    increase, with the Department of Healthcare and Family
11    Services.
12        (2) After completing the calculation in paragraph (1),
13    any facility whose rate is less than the rate in effect on
14    June 30, 2019 shall have its rate restored to the rate in
15    effect on June 30, 2019 from the 20% of the funds set
16    aside.
17        (3) The remainder of the 20%, or $34,000,000, shall be
18    used to increase each facility's rate by an equal
19    percentage.
20    (k) During the first quarter of State Fiscal Year 2020,
21the Department of Healthcare of Family Services must convene a
22technical advisory group consisting of members of all trade
23associations representing Illinois skilled nursing providers
24to discuss changes necessary with federal implementation of
25Medicare's Patient-Driven Payment Model. Implementation of
26Medicare's Patient-Driven Payment Model shall, by September 1,

 

 

10200HB4846sam001- 35 -LRB102 25362 AMQ 41930 a

12020, end the collection of the MDS data that is necessary to
2maintain the current RUG-IV Medicaid payment methodology. The
3technical advisory group must consider a revised reimbursement
4methodology that takes into account transparency,
5accountability, actual staffing as reported under the
6federally required Payroll Based Journal system, changes to
7the minimum wage, adequacy in coverage of the cost of care, and
8a quality component that rewards quality improvements.
9    (l) The Department shall establish per diem add-on
10payments to improve the quality of care delivered by
11facilities, including:
12        (1) Incentive payments determined by facility
13    performance on specified quality measures in an initial
14    amount of $70,000,000. Nothing in this subsection shall be
15    construed to limit the quality of care payments in the
16    aggregate statewide to $70,000,000, and, if quality of
17    care has improved across nursing facilities, the
18    Department shall adjust those add-on payments accordingly.
19    The quality payment methodology described in this
20    subsection must be used for at least State Fiscal Year
21    2023. Beginning with the quarter starting July 1, 2023,
22    the Department may add, remove, or change quality metrics
23    and make associated changes to the quality payment
24    methodology as outlined in subparagraph (E). Facilities
25    designated by the Centers for Medicare and Medicaid
26    Services as a special focus facility or a hospital-based

 

 

10200HB4846sam001- 36 -LRB102 25362 AMQ 41930 a

1    nursing home do not qualify for quality payments.
2            (A) Each quality pool must be distributed by
3        assigning a quality weighted score for each nursing
4        home which is calculated by multiplying the nursing
5        home's quality base period Medicaid days by the
6        nursing home's star rating weight in that period.
7            (B) Star rating weights are assigned based on the
8        nursing home's star rating for the LTS quality star
9        rating. As used in this subparagraph, "LTS quality
10        star rating" means the long-term stay quality rating
11        for each nursing facility, as assigned by the Centers
12        for Medicare and Medicaid Services under the Five-Star
13        Quality Rating System. The rating is a number ranging
14        from 0 (lowest) to 5 (highest).
15                (i) Zero-star or one-star rating has a weight
16            of 0.
17                (ii) Two-star rating has a weight of 0.75.
18                (iii) Three-star rating has a weight of 1.5.
19                (iv) Four-star rating has a weight of 2.5.
20                (v) Five-star rating has a weight of 3.5.
21            (C) Each nursing home's quality weight score is
22        divided by the sum of all quality weight scores for
23        qualifying nursing homes to determine the proportion
24        of the quality pool to be paid to the nursing home.
25            (D) The quality pool is no less than $70,000,000
26        annually or $17,500,000 per quarter. The Department

 

 

10200HB4846sam001- 37 -LRB102 25362 AMQ 41930 a

1        shall publish on its website the estimated payments
2        and the associated weights for each facility 45 days
3        prior to when the initial payments for the quarter are
4        to be paid. The Department shall assign each facility
5        the most recent and applicable quarter's STAR value
6        unless the facility notifies the Department within 15
7        days of an issue and the facility provides reasonable
8        evidence demonstrating its timely compliance with
9        federal data submission requirements for the quarter
10        of record. If such evidence cannot be provided to the
11        Department, the STAR rating assigned to the facility
12        shall be reduced by one from the prior quarter.
13            (E) The Department shall review quality metrics
14        used for payment of the quality pool and make
15        recommendations for any associated changes to the
16        methodology for distributing quality pool payments in
17        consultation with associations representing long-term
18        care providers, consumer advocates, organizations
19        representing workers of long-term care facilities, and
20        payors. The Department may establish, by rule, changes
21        to the methodology for distributing quality pool
22        payments.
23            (F) The Department shall disburse quality pool
24        payments from the Long-Term Care Provider Fund on a
25        monthly basis in amounts proportional to the total
26        quality pool payment determined for the quarter.

 

 

10200HB4846sam001- 38 -LRB102 25362 AMQ 41930 a

1            (G) The Department shall publish any changes in
2        the methodology for distributing quality pool payments
3        prior to the beginning of the measurement period or
4        quality base period for any metric added to the
5        distribution's methodology.
6        (2) Payments based on CNA tenure, promotion, and CNA
7    training for the purpose of increasing CNA compensation.
8    It is the intent of this subsection that payments made in
9    accordance with this paragraph be directly incorporated
10    into increased compensation for CNAs. As used in this
11    paragraph, "CNA" means a certified nursing assistant as
12    that term is described in Section 3-206 of the Nursing
13    Home Care Act, Section 3-206 of the ID/DD Community Care
14    Act, and Section 3-206 of the MC/DD Act. The Department
15    shall establish, by rule, payments to nursing facilities
16    equal to Medicaid's share of the tenure wage increments
17    specified in this paragraph for all reported CNA employee
18    hours compensated according to a posted schedule
19    consisting of increments at least as large as those
20    specified in this paragraph. The increments are as
21    follows: an additional $1.50 per hour for CNAs with at
22    least one and less than 2 years' experience plus another
23    $1 per hour for each additional year of experience up to a
24    maximum of $6.50 for CNAs with at least 6 years of
25    experience. For purposes of this paragraph, Medicaid's
26    share shall be the ratio determined by paid Medicaid bed

 

 

10200HB4846sam001- 39 -LRB102 25362 AMQ 41930 a

1    days divided by total bed days for the applicable time
2    period used in the calculation. In addition, and additive
3    to any tenure increments paid as specified in this
4    paragraph, the Department shall establish, by rule,
5    payments supporting Medicaid's share of the
6    promotion-based wage increments for CNA employee hours
7    compensated for that promotion with at least a $1.50
8    hourly increase. Medicaid's share shall be established as
9    it is for the tenure increments described in this
10    paragraph. Qualifying promotions shall be defined by the
11    Department in rules for an expected 10-15% subset of CNAs
12    assigned intermediate, specialized, or added roles such as
13    CNA trainers, CNA scheduling "captains", and CNA
14    specialists for resident conditions like dementia or
15    memory care or behavioral health.
16    (m) The Department shall work with nursing facility
17industry representatives to design policies and procedures to
18permit facilities to address the integrity of data from
19federal reporting sites used by the Department in setting
20facility rates.
21(Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19;
22102-77, eff. 7-9-21; 102-558, eff. 8-20-21; 102-1035, eff.
235-31-22.)
 
24    (305 ILCS 5/5-5.7b)
25    Sec. 5-5.7b. Pandemic related stability payments to

 

 

10200HB4846sam001- 40 -LRB102 25362 AMQ 41930 a

1ambulance service providers in response to COVID-19.
2    (a) Definitions. As used in this Section:
3    "Ambulance Services Industry" means the industry that is
4comprised of "Qualifying Ground Ambulance Service Providers",
5as defined in this Section.
6    "Qualifying Ground Ambulance Service Provider" means a
7"vehicle service provider," as that term is defined in Section
83.85 of the Emergency Medical Services (EMS) Systems Act,
9which operates licensed ambulances for the purpose of
10providing emergency, non-emergency ambulance services, or both
11emergency and non-emergency ambulance services. The term
12"Qualifying Ground Ambulance Service Provider" is limited to
13ambulance and EMS agencies that are privately held and
14nonprofit organizations headquartered within the State and
15licensed by the Department of Public Health as of March 12,
162020.
17    "Eligible worker" means a staff member of a Qualifying
18Ground Ambulance Service Provider engaged in "essential work",
19as defined by Section 9901 of the ARPA and related federal
20guidance, and (1) whose total pay is below 150% of the average
21annual wage for all occupations in the worker's county of
22residence, as defined by the BLS Occupational Employment and
23Wage Statistics or (2) is not exempt from the federal Fair
24Labor Standards Act overtime provisions.
25    (b) Purpose. The Department may receive federal funds
26under the authority of legislation passed in response to the

 

 

10200HB4846sam001- 41 -LRB102 25362 AMQ 41930 a

1Coronavirus epidemic, including, but not limited to, the
2American Rescue Plan Act of 2021, P.L. 117-2 (the "ARPA").
3Upon receipt or availability of such State or federal funds,
4and subject to appropriations for their use, the Department
5shall establish and administer programs for purposes allowable
6under Section 9901 of the ARPA to provide financial assistance
7to Qualifying Ground Ambulance Service Providers for premium
8pay for eligible workers, to provide reimbursement for
9eligible expenditures, and to provide support following the
10negative economic impact of the COVID-19 public health
11emergency on the Ambulance Services Industry. Financial
12assistance may include, but is not limited to, grants, expense
13reimbursements, or subsidies.
14    (b-1) By December 31, 2022, the Department shall obtain
15appropriate documentation from Qualifying Ground Ambulance
16Service Providers to ascertain an accurate count of the number
17of licensed vehicles available to serve enrollees in the
18State's Medical Assistance Programs, which shall be known as
19the "total eligible vehicles". By February 28, 2023,
20Qualifying Ground Ambulance Service Providers shall be
21initially notified of their eligible award, which shall be the
22product of (i) the total amount of funds allocated under this
23Section and (ii) a quotient, the numerator of which is the
24number of licensed ground ambulance vehicles of an individual
25Qualifying Ground Ambulance Service Provider and the
26denominator of which is the total eligible vehicles. After

 

 

10200HB4846sam001- 42 -LRB102 25362 AMQ 41930 a

1March 31, 2024, any unobligated funds shall be reallocated pro
2rata to the remaining Qualifying Ground Ambulance Service
3Providers that are able to prove up eligible expenses in
4excess of their initial award amount until all such
5appropriated funds are exhausted.
6    Providers shall indicate to the Department what portion of
7their award they wish to allocate under the purposes outlined
8under paragraphs (d), (e), or (f), if applicable, of this
9Section.
10    (c) Non-Emergency Service Certification. To be eligible
11for funding under this Section, a Qualifying Ground Ambulance
12Service Provider that provides non-emergency services to
13institutional residents must certify whether or not it is able
14to that it will provide non-emergency ambulance services to
15individuals enrolled in the State's Medical Assistance Program
16and residing in non-institutional settings for at least one
17year following the receipt of funding pursuant to this
18amendatory Act of the 102nd General Assembly. Certification
19indicating that a provider has such an ability does not mean
20that a provider is required to accept any or all requested
21transports. The provider shall maintain the certification in
22its records. The provider shall also maintain documentation of
23all non-emergency ambulance services for the period covered by
24the certification. The provider shall produce the
25certification and supporting documentation upon demand by the
26Department or its representative. Failure to comply shall

 

 

10200HB4846sam001- 43 -LRB102 25362 AMQ 41930 a

1result in recovery of any payments made by the Department.
2    (d) Premium Pay Initiative. Subject to paragraph (c) of
3this Section, the Department shall establish a Premium Pay
4Initiative to distribute awards to each Qualifying Ground
5Ambulance Service Provider for the purpose of providing
6premium pay to eligible workers.
7        (1) Financial assistance pursuant to this paragraph
8    (d) shall be scaled based on a process determined by the
9    Department. The amount awarded to each Qualifying Ground
10    Ambulance Service Provider shall be up to $13 per hour for
11    each eligible worker employed.
12        (2) The financial assistance awarded shall only be
13    expended for premium pay for eligible workers, which must
14    be in addition to any wages or remuneration the eligible
15    worker has already received and shall be subject to the
16    other requirements and limitations set forth in the ARPA
17    and related federal guidance.
18        (3) Upon receipt of funds, the Qualifying Ground
19    Ambulance Service Provider shall distribute funds such
20    that an eligible worker receives an amount up to $13 per
21    hour but no more than $25,000 for the duration of the
22    program. The Qualifying Ground Ambulance Service Provider
23    shall provide a written certification to the Department
24    acknowledging compliance with this paragraph (d).
25        (4) No portion of these funds shall be spent on
26    volunteer staff.

 

 

10200HB4846sam001- 44 -LRB102 25362 AMQ 41930 a

1        (5) These funds shall not be used to make retroactive
2    premium payments prior to the effective date of this
3    amendatory Act of the 102nd General Assembly.
4        (6) The Department shall require each Qualifying
5    Ground Ambulance Service Provider that receives funds
6    under this paragraph (d) to submit appropriate
7    documentation acknowledging compliance with State and
8    federal law on an annual basis.
9    (e) COVID-19 Response Support Initiative. Subject to
10paragraph (c) of this Section and based on an application
11filed by a Qualifying Ground Ambulance Service Provider, the
12Department shall establish the Ground Ambulance COVID-19
13Response Support Initiative. The purpose of the award shall be
14to reimburse Qualifying Ground Ambulance Service Providers for
15eligible expenses under Section 9901 of the ARPA related to
16the public health impacts of the COVID-19 public health
17emergency, including, but not limited to: (i) costs incurred
18due to the COVID-19 public health emergency; (ii) costs
19related to vaccination programs, including vaccine incentives;
20(iii) costs related to COVID-19 testing; (iv) costs related to
21COVID-19 prevention and treatment equipment; (v) expenses for
22medical supplies; (vi) expenses for personal protective
23equipment; (vii) costs related to isolation and quarantine;
24(viii) costs for ventilation system installation and
25improvement; (ix) costs related to other emergency response
26equipment, such as ground ambulances, ventilators, cardiac

 

 

10200HB4846sam001- 45 -LRB102 25362 AMQ 41930 a

1monitoring equipment, defibrillation equipment, pacing
2equipment, ambulance stretchers, and radio equipment; and (x)
3other emergency medical response expenses. costs related to
4COVID-19 testing for patients, COVID-19 prevention and
5treatment equipment, medical supplies, personal protective
6equipment, and other emergency medical response treatments.
7        (1) The award shall be for eligible obligated
8    expenditures incurred no earlier than May 1, 2022 and no
9    later than June 30, 2024 2023. Expenditures under this
10    paragraph must be incurred by June 30, 2025.
11        (2) Funds awarded under this paragraph (e) shall not
12    be expended for premium pay to eligible workers.
13        (3) The Department shall require each Qualifying
14    Ground Ambulance Service Provider that receives funds
15    under this paragraph (e) to submit appropriate
16    documentation acknowledging compliance with State and
17    federal law on an annual basis. For purchases of medical
18    equipment or other capital expenditures, the Qualifying
19    Ground Ambulance Service Provider shall include
20    documentation that describes the harm or need to be
21    addressed by the expenditures and how that capital
22    expenditure is appropriate to address that identified harm
23    or need.
24    (f) Ambulance Industry Recovery Program. If the Department
25designates the Ambulance Services Industry as an "impacted
26industry", as defined by the ARPA and related federal

 

 

10200HB4846sam001- 46 -LRB102 25362 AMQ 41930 a

1guidance, the Department shall establish the Ambulance
2Industry Recovery Grant Program, to provide aid to Qualifying
3Ground Ambulance Service Providers that experienced staffing
4losses due to the COVID-19 public health emergency.
5        (1) Funds awarded under this paragraph (f) shall not
6    be expended for premium pay to eligible workers.
7        (2) Each Qualifying Ground Ambulance Service Provider
8    that receives funds under this paragraph (f) shall comply
9    with paragraph (c) of this Section.
10        (3) The Department shall require each Qualifying
11    Ground Ambulance Service Provider that receives funds
12    under this paragraph (f) to submit appropriate
13    documentation acknowledging compliance with State and
14    federal law on an annual basis.
15(Source: P.A. 102-699, eff. 4-19-22.)
 
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

 

 

10200HB4846sam001- 47 -LRB102 25362 AMQ 41930 a

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

 

 

10200HB4846sam001- 48 -LRB102 25362 AMQ 41930 a

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 or a nursing facility owned and
8    operated by a county government, $7 per occupied bed day.
9    Notwithstanding any provision of any other Act to the
10contrary, this assessment shall be construed as a tax but
11shall not be billed or passed on to any resident of a nursing
12home operated by the nursing home provider.
13    For each new calendar year and for the 6-month period
14beginning July 1, 2022, a facility's paid Medicaid resident
15days per annum shall be determined using the Department's
16Medicaid Management Information System to include Medicaid
17resident days for the year ending 9 months earlier.
18    (b) Nothing in this amendatory Act of 1992 shall be
19construed to authorize any home rule unit or other unit of
20local government to license for revenue or impose a tax or
21assessment upon long-term care providers or the occupation of
22long-term care provider, or a tax or assessment measured by
23the income or earnings or occupied bed days of a long-term care
24provider.
25    (c) The assessment imposed by this Section shall not be
26due and payable, however, until after the Department notifies

 

 

10200HB4846sam001- 49 -LRB102 25362 AMQ 41930 a

1the long-term care providers, in writing, that the payment
2methodologies to long-term care providers required under
3Section 5-5.2 of this Code have been approved by the Centers
4for Medicare and Medicaid Services of the U.S. Department of
5Health and Human Services and that the waivers under 42 CFR
6433.68 for the assessment imposed by this Section, if
7necessary, have been granted by the Centers for Medicare and
8Medicaid Services of the U.S. Department of Health and Human
9Services.
10(Source: P.A. 102-1035, eff. 5-31-22.)
 
11    Section 99. Effective date. This Act takes effect upon
12becoming law.".