Full Text of HB4846 102nd General Assembly
HB4846sam001 102ND GENERAL ASSEMBLY | Sen. Ann Gillespie Filed: 11/29/2022
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| 1 | | AMENDMENT TO HOUSE BILL 4846
| 2 | | AMENDMENT NO. ______. Amend House Bill 4846 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Administrative Procedure Act is | 5 | | amended 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 | 8 | | hospitals. To provide for the expeditious and timely | 9 | | implementation of this amendatory Act of the 102nd General | 10 | | Assembly, emergency rules implementing the inclusion of rural | 11 | | emergency hospitals in the definition of "hospital" in Section | 12 | | 3 of the Hospital Licensing Act may be adopted in accordance | 13 | | with Section 5-45 by the Department of Public Health. The | 14 | | adoption of emergency rules authorized by Section 5-45 and | 15 | | this Section is deemed to be necessary for the public | 16 | | interest, safety, and welfare. |
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| 1 | | This Section is repealed one year after the effective date | 2 | | of this amendatory Act of the 102nd General Assembly. | 3 | | Section 10. The Hospital Licensing Act is amended by | 4 | | changing 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, | 8 | | buildings on a campus, or agency, public
or private, whether | 9 | | organized for profit or not, devoted primarily to the
| 10 | | maintenance and operation of facilities for the diagnosis and | 11 | | treatment or
care of 2 or more unrelated persons admitted for | 12 | | overnight stay or longer
in order to obtain medical, including | 13 | | obstetric, psychiatric and nursing,
care of illness, disease, | 14 | | injury, infirmity, or deformity.
| 15 | | The term "hospital", without regard to length of stay, | 16 | | shall 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 . |
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| 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 | 12 | | hospitals,
tuberculosis sanitaria, mental or psychiatric | 13 | | hospitals and sanitaria, and
includes maternity homes, | 14 | | lying-in homes, and homes for unwed mothers in
which care is | 15 | | given 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 |
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| 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 | 21 | | subdivision or municipal
corporation, individual, firm, | 22 | | partnership, corporation, company,
association, or joint stock | 23 | | association, or the legal successor thereof.
| 24 | | (C) "Department" means the Department of Public Health of | 25 | | the State of
Illinois.
| 26 | | (D) "Director" means the Director of Public Health of
the |
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| 1 | | State of Illinois.
| 2 | | (E) "Perinatal" means the period of time
between the | 3 | | conception of an
infant and the end of the first month after | 4 | | birth.
| 5 | | (F) "Federally designated organ procurement agency" means | 6 | | the organ
procurement agency designated by the Secretary of | 7 | | the U.S. Department of Health
and Human Services for the | 8 | | service area in which a hospital is located; except
that in the | 9 | | case of a hospital located in a county adjacent to Wisconsin
| 10 | | which currently contracts with an organ procurement agency | 11 | | located in Wisconsin
that is not the organ procurement agency | 12 | | designated by the U.S. Secretary of
Health and Human Services | 13 | | for the service area in which the hospital is
located, if the | 14 | | hospital applies for a waiver pursuant to 42 U.S.C. USC
| 15 | | 1320b-8(a), it may designate an organ procurement agency
| 16 | | located in Wisconsin to be thereafter deemed its federally | 17 | | designated organ
procurement agency for the purposes of this | 18 | | Act.
| 19 | | (G) "Tissue bank" means any facility or program operating | 20 | | in Illinois
that is certified by the American Association of | 21 | | Tissue Banks or the Eye Bank
Association of America and is | 22 | | involved in procuring, furnishing, donating,
or distributing | 23 | | corneas, bones, or other human tissue for the purpose of
| 24 | | injecting, transfusing, or transplanting any of them into the | 25 | | human body.
"Tissue bank" does not include a licensed blood | 26 | | bank. For the purposes of this
Act, "tissue" does not include |
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| 1 | | organs.
| 2 | | (H) "Campus", as this term terms applies to operations, | 3 | | has the same meaning as the term "campus" as set forth in | 4 | | federal 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 | 7 | | by 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 | 12 | | analyst 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 |
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| 1 | | (5) has paid the required fees. | 2 | | (b) The Department may issue a license to a certified | 3 | | behavior analyst seeking licensure as a licensed behavior | 4 | | analyst
who (i) does not have the supervised experience as | 5 | | described in paragraph (3) of subsection (a), (ii) applies for | 6 | | licensure before July 1, 2028, and (iii) has completed all of | 7 | | the 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 | 20 | | to complete the application process. If the process has not | 21 | | been completed in 3 years, the application shall be denied, | 22 | | the fee shall be forfeited, and the applicant must reapply and | 23 | | meet the requirements in effect at the time of reapplication. | 24 | | (d) Each applicant for licensure as a an behavior analyst | 25 | | shall have his or her fingerprints submitted to the Illinois | 26 | | State Police in an electronic format that complies with the |
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| 1 | | form and manner for requesting and furnishing criminal history | 2 | | record information as prescribed by the Illinois State Police. | 3 | | These fingerprints shall be transmitted through a live scan | 4 | | fingerprint vendor licensed by the Department. These | 5 | | fingerprints shall be checked against the Illinois State | 6 | | Police and Federal Bureau of Investigation criminal history | 7 | | record databases now and hereafter filed, including, but not | 8 | | limited to, civil, criminal, and latent fingerprint databases. | 9 | | The Illinois State Police shall charge a fee for conducting | 10 | | the criminal history records check, which shall be deposited | 11 | | in the State Police Services Fund and shall not exceed the | 12 | | actual cost of the records check. The Illinois State Police | 13 | | shall furnish, pursuant to positive identification, records of | 14 | | Illinois convictions as prescribed under the Illinois Uniform | 15 | | Conviction Information Act and shall forward the national | 16 | | criminal 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 | 21 | | license. | 22 | | (a) A person qualifies to be licensed as an assistant | 23 | | behavior analyst if that person: | 24 | | (1) has applied in writing or electronically on forms | 25 | | prescribed by the Department; |
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| 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 | 12 | | assistant behavior analyst seeking licensure as a licensed | 13 | | assistant behavior analyst who (i) does not have the | 14 | | supervised experience as described in paragraph (3) of | 15 | | subsection (a), (ii) applies for licensure before July 1, | 16 | | 2028, 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. |
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| 1 | | (c) An applicant has 3 years after the date of application | 2 | | to complete the application process. If the process has not | 3 | | been completed in 3 years, the application shall be denied, | 4 | | the fee shall be forfeited, and the applicant must reapply and | 5 | | meet the requirements in effect at the time of reapplication. | 6 | | (d) Each applicant for licensure as an assistant behavior | 7 | | analyst shall have his or her fingerprints submitted to the | 8 | | Illinois State Police in an electronic format that complies | 9 | | with the form and manner for requesting and furnishing | 10 | | criminal history record information as prescribed by the | 11 | | Illinois State Police. These fingerprints shall be transmitted | 12 | | through a live scan fingerprint vendor licensed by the | 13 | | Department. These fingerprints shall be checked against the | 14 | | Illinois State Police and Federal Bureau of Investigation | 15 | | criminal history record databases now and hereafter filed, | 16 | | including, but not limited to, civil, criminal, and latent | 17 | | fingerprint databases. The Illinois State Police shall charge | 18 | | a fee for conducting the criminal history records check, which | 19 | | shall be deposited in the State Police Services Fund and shall | 20 | | not exceed the actual cost of the records check. The Illinois | 21 | | State Police shall furnish, pursuant to positive | 22 | | identification, records of Illinois convictions as prescribed | 23 | | under the Illinois Uniform Conviction Information Act and | 24 | | shall forward the national criminal history record information | 25 | | to the Department.
| 26 | | (Source: P.A. 102-953, eff. 5-27-22; revised 8-19-22.) |
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| 1 | | (225 ILCS 6/150) | 2 | | (Section scheduled to be repealed on January 1, 2028)
| 3 | | Sec. 150. License restrictions and limitations. | 4 | | Notwithstanding the exclusion in paragraph (2) of subsection | 5 | | (c) of Section 20 that permits an individual to implement a | 6 | | behavior analytic treatment plan under the extended authority, | 7 | | direction, and supervision of a licensed behavior analyst or | 8 | | licensed assistant behavior analyst, no No business | 9 | | organization shall provide, attempt to provide, or offer to | 10 | | provide behavior analysis services unless every member, | 11 | | partner, shareholder, director, officer, holder of any other | 12 | | ownership interest, agent, and employee who renders applied | 13 | | behavior analysis services holds a currently valid license | 14 | | issued under this Act. No business shall be created that (i) | 15 | | has a stated purpose that includes behavior analysis, or (ii) | 16 | | practices or holds itself out as available to practice | 17 | | behavior analysis therapy, unless it is organized under the | 18 | | Professional Service Corporation Act or Professional Limited | 19 | | Liability Company Act. Nothing in this Act shall preclude | 20 | | individuals licensed under this Act from practicing directly | 21 | | or indirectly for a physician licensed to practice medicine in | 22 | | all its branches under the Medical Practice Act of 1987 or for | 23 | | any legal entity as provided under subsection (c) of Section | 24 | | 22.2 of the Medical Practice Act of 1987.
| 25 | | (Source: P.A. 102-953, eff. 5-27-22.) |
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| 1 | | Section 20. The Podiatric Medical Practice Act of 1987 is | 2 | | amended by adding Section 18.1 as follows: | 3 | | (225 ILCS 100/18.1 new) | 4 | | Sec. 18.1. Fee waivers. Notwithstanding any provision of | 5 | | law to the contrary, during State Fiscal Year 2023, the | 6 | | Department shall allow individuals a one-time waiver of fees | 7 | | imposed under Section 18 of this Act. No individual may | 8 | | benefit from such a waiver more than once. If an individual has | 9 | | already paid a fee required under Section 18 for Fiscal Year | 10 | | 2023, then the Department shall apply the money paid for that | 11 | | fee as a credit to the next required fee. | 12 | | Section 25. The Illinois Public Aid Code is amended by | 13 | | changing 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 | 17 | | September 30, 1992.
Notwithstanding any other provisions of | 18 | | this Code or the Illinois
Department's Rules promulgated under | 19 | | the Illinois Administrative Procedure
Act, reimbursement to | 20 | | hospitals for services provided during the period
July 1, 1992 | 21 | | through September 30, 1992, shall be as follows:
| 22 | | (1) For inpatient hospital services rendered, or if |
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| 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 |
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| 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 | 12 | | or after October
1, 1993, in addition to rates paid for | 13 | | hospital inpatient services pursuant to
the Illinois Health | 14 | | Finance Reform Act, as now or hereafter amended, or the
| 15 | | Illinois Department's prospective reimbursement methodology, | 16 | | or any other
methodology used by the Illinois Department for | 17 | | inpatient services, the
Illinois Department shall make | 18 | | adjustment payments, in an amount calculated
pursuant to the | 19 | | methodology described in paragraph (c) of this Section, to
| 20 | | hospitals that the Illinois Department determines satisfy any | 21 | | one 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 |
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| 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 |
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| 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 |
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| 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 | 14 | | required by
paragraph (b) shall be calculated based upon the | 15 | | hospital'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;
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| 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 | 24 | | thereafter, the Medicaid Inpatient utilization rate, as | 25 | | defined in paragraph (1) of subsection (h) and used in the | 26 | | determination of eligibility for payments under paragraph (c), |
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| 1 | | shall be modified to exclude from both the numerator and | 2 | | denominator all days of care provided to military recruits or | 3 | | trainees for the United States Navy and covered by TriCare or | 4 | | its successor. | 5 | | (d) Supplemental adjustment payments. In addition to the | 6 | | adjustment
payments described in paragraph (c), hospitals as | 7 | | defined in clauses
(1) through (6) of paragraph (b), excluding | 8 | | county hospitals (as defined in
subsection (c) of Section 15-1 | 9 | | of this Code) and a hospital organized under the
University of | 10 | | Illinois Hospital Act, shall be paid supplemental inpatient
| 11 | | adjustment payments of $60 per day. For purposes of Title XIX | 12 | | of the federal
Social Security Act, these supplemental | 13 | | adjustment payments shall not be
classified as adjustment | 14 | | payments to disproportionate share hospitals.
| 15 | | (e) The inpatient adjustment payments described in | 16 | | paragraphs (c) and (d)
shall be increased on October 1, 1993 | 17 | | and annually thereafter by a percentage
equal to the lesser of | 18 | | (i) the increase in the DRI hospital cost index for the
most | 19 | | recent 12-month 12 month period for which data are available, | 20 | | or (ii) the
percentage increase in the statewide average | 21 | | hospital payment rate over the
previous year's statewide | 22 | | average hospital payment rate. The sum of the
inpatient | 23 | | adjustment payments under paragraphs (c) and (d) to a | 24 | | hospital, other
than a county hospital (as defined in | 25 | | subsection (c) of Section 15-1 of this
Code) or a hospital | 26 | | organized under the University of Illinois Hospital Act,
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| 1 | | however, shall not exceed $275 per day; that limit shall be | 2 | | increased on
October 1, 1993 and annually thereafter by a | 3 | | percentage equal to the lesser of
(i) the increase in the DRI | 4 | | hospital cost index for the most recent 12-month
period for | 5 | | which data are available or (ii) the percentage increase in | 6 | | the
statewide average hospital payment rate over the previous | 7 | | year's statewide
average hospital payment rate.
| 8 | | (f) Children's hospital inpatient adjustment payments. For | 9 | | children'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 | 13 | | county hospitals,
as defined in subsection (c) of Section 15-1 | 14 | | of this Code, there shall be an
adjustment payment as | 15 | | determined by rules issued by the Illinois Department.
| 16 | | (h) For the purposes of this Section the following terms | 17 | | shall 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 |
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| 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 | 9 | | the limits
of Public Law 102-234 and Public Law 103-66, the
| 10 | | Illinois Department shall by rule adjust
disproportionate | 11 | | share adjustment payments.
| 12 | | (j) University of Illinois Hospital inpatient adjustment | 13 | | payments. For
hospitals organized under the University of | 14 | | Illinois Hospital Act, there shall
be an adjustment payment as | 15 | | determined by rules adopted by the Illinois
Department.
| 16 | | (k) The Illinois Department may by rule establish criteria | 17 | | for and develop
methodologies for adjustment payments to | 18 | | hospitals participating under this
Article.
| 19 | | (l) On and after July 1, 2012, the Department shall reduce | 20 | | any rate of reimbursement for services or other payments or | 21 | | alter any methodologies authorized by this Code to reduce any | 22 | | rate of reimbursement for services or other payments in | 23 | | accordance with Section 5-5e. | 24 | | (m) The Department shall establish a cost-based | 25 | | reimbursement methodology for determining payments to | 26 | | hospitals for approved graduate medical education (GME) |
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| 1 | | programs 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 |
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| 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; | 24 | | 102-886, eff. 5-17-22.)
| 25 | | (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
|
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| 1 | | Sec. 5-5.2. Payment.
| 2 | | (a) All nursing facilities that are grouped pursuant to | 3 | | Section
5-5.1 of this Act shall receive the same rate of | 4 | | payment for similar
services.
| 5 | | (b) It shall be a matter of State policy that the Illinois | 6 | | Department
shall utilize a uniform billing cycle throughout | 7 | | the State for the
long-term care providers.
| 8 | | (c) (Blank). | 9 | | (c-1) Notwithstanding any other provisions of this Code, | 10 | | the methodologies for reimbursement of nursing services as | 11 | | provided under this Article shall no longer be applicable for | 12 | | bills payable for nursing services rendered on or after a new | 13 | | reimbursement system based on the Patient Driven Payment Model | 14 | | (PDPM) has been fully operationalized, which shall take effect | 15 | | for services provided on or after the implementation of the | 16 | | PDPM reimbursement system begins. For the purposes of this | 17 | | amendatory Act of the 102nd General Assembly, the | 18 | | implementation date of the PDPM reimbursement system and all | 19 | | related provisions shall be July 1, 2022 if the following | 20 | | conditions are met: (i) the Centers for Medicare and Medicaid | 21 | | Services has approved corresponding changes in the | 22 | | reimbursement system and bed assessment; and (ii) the | 23 | | Department has filed rules to implement these changes no later | 24 | | than June 1, 2022. Failure of the Department to file rules to | 25 | | implement the changes provided in this amendatory Act of the | 26 | | 102nd General Assembly no later than June 1, 2022 shall result |
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| 1 | | in the implementation date being delayed to October 1, 2022. | 2 | | (d) The new nursing services reimbursement methodology | 3 | | utilizing the Patient Driven Payment Model, which shall be | 4 | | referred to as the PDPM reimbursement system, taking effect | 5 | | July 1, 2022, upon federal approval by the Centers for | 6 | | Medicare and Medicaid Services, shall be based on the | 7 | | following: | 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 | 4 | | base 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. |
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| 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 |
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| 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 | 5 | | funding in the amount up to $10,000,000 for per diem add-ons to | 6 | | the RUGS methodology for dates of service on and after July 1, | 7 | | 2014: | 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 | 18 | | ending September 30, 2023, the RUG-IV nursing component per | 19 | | diem for a nursing home shall be the product of the statewide | 20 | | RUG-IV nursing base per diem rate, the facility average case | 21 | | mix index, and the regional wage adjustor. | 22 | | (e-3) A Medicaid Access Adjustment of $4 adjusted for the | 23 | | facility average PDPM case mix index calculated quarterly | 24 | | shall be added to the statewide PDPM nursing per diem for all | 25 | | facilities with annual Medicaid bed days of at least 70% of all | 26 | | occupied bed days adjusted quarterly. For each new calendar |
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| 1 | | year and for the 6-month period beginning July 1, 2022, the | 2 | | percentage of a facility's occupied bed days comprised of | 3 | | Medicaid bed days shall be determined by the Department | 4 | | quarterly. Beginning on the effective date of this amendatory | 5 | | Act of the 102nd General Assembly, the Medicaid Access | 6 | | Adjustment of $4 shall be increased by $0.75 and the increased | 7 | | reimbursement rate shall be applied to services rendered on | 8 | | and after July 1, 2022. The Department shall recalculate each | 9 | | affected facility's reimbursement rate retroactive to July 1, | 10 | | 2022 and remit all additional money owed to each facility as a | 11 | | result of the retroactive recalculation. This subsection shall | 12 | | be inoperative on and after January 1, 2028. | 13 | | (f) (Blank). | 14 | | (g) Notwithstanding any other provision of this Code, on | 15 | | and after July 1, 2012, for facilities not designated by the | 16 | | Department of Healthcare and Family Services as "Institutions | 17 | | for Mental Disease", rates effective May 1, 2011 shall be | 18 | | adjusted 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 | 24 | | and after July 1, 2012, nursing facilities designated by the | 25 | | Department of Healthcare and Family Services as "Institutions | 26 | | for Mental Disease" and "Institutions for Mental Disease" that |
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| 1 | | are facilities licensed under the Specialized Mental Health | 2 | | Rehabilitation Act of 2013 shall have the nursing, | 3 | | socio-developmental, capital, and support components of their | 4 | | reimbursement rate effective May 1, 2011 reduced in total by | 5 | | 2.7%. | 6 | | (i) On and after July 1, 2014, the reimbursement rates for | 7 | | the support component of the nursing facility rate for | 8 | | facilities licensed under the Nursing Home Care Act as skilled | 9 | | or intermediate care facilities shall be the rate in effect on | 10 | | June 30, 2014 increased by 8.17%. | 11 | | (j) Notwithstanding any other provision of law, subject to | 12 | | federal approval, effective July 1, 2019, sufficient funds | 13 | | shall be allocated for changes to rates for facilities | 14 | | licensed under the Nursing Home Care Act as skilled nursing | 15 | | facilities or intermediate care facilities for dates of | 16 | | services on and after July 1, 2019: (i) to establish, through | 17 | | June 30, 2022 a per diem add-on to the direct care per diem | 18 | | rate not to exceed $70,000,000 annually in the aggregate | 19 | | taking into account federal matching funds for the purpose of | 20 | | addressing the facility's unique staffing needs, adjusted | 21 | | quarterly and distributed by a weighted formula based on | 22 | | Medicaid bed days on the last day of the second quarter | 23 | | preceding the quarter for which the rate is being adjusted. | 24 | | Beginning July 1, 2022, the annual $70,000,000 described in | 25 | | the preceding sentence shall be dedicated to the variable per | 26 | | diem add-on for staffing under paragraph (6) of subsection |
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| 1 | | (d); and (ii) in an amount not to exceed $170,000,000 annually | 2 | | in the aggregate taking into account federal matching funds to | 3 | | permit the support component of the nursing facility rate to | 4 | | be 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, | 21 | | the Department of Healthcare of Family Services must convene a | 22 | | technical advisory group consisting of members of all trade | 23 | | associations representing Illinois skilled nursing providers | 24 | | to discuss changes necessary with federal implementation of | 25 | | Medicare's Patient-Driven Payment Model. Implementation of | 26 | | Medicare's Patient-Driven Payment Model shall, by September 1, |
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| 1 | | 2020, end the collection of the MDS data that is necessary to | 2 | | maintain the current RUG-IV Medicaid payment methodology. The | 3 | | technical advisory group must consider a revised reimbursement | 4 | | methodology that takes into account transparency, | 5 | | accountability, actual staffing as reported under the | 6 | | federally required Payroll Based Journal system, changes to | 7 | | the minimum wage, adequacy in coverage of the cost of care, and | 8 | | a quality component that rewards quality improvements. | 9 | | (l) The Department shall establish per diem add-on | 10 | | payments to improve the quality of care delivered by | 11 | | facilities, 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 |
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| 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 |
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| 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. |
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| 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 |
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| 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 | 17 | | industry representatives to design policies and procedures to | 18 | | permit facilities to address the integrity of data from | 19 | | federal reporting sites used by the Department in setting | 20 | | facility rates. | 21 | | (Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19; | 22 | | 102-77, eff. 7-9-21; 102-558, eff. 8-20-21; 102-1035, eff. | 23 | | 5-31-22 .)
| 24 | | (305 ILCS 5/5-5.7b) | 25 | | Sec. 5-5.7b. Pandemic related stability payments to |
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| 1 | | ambulance service providers in response to COVID-19. | 2 | | (a) Definitions. As used in this Section: | 3 | | "Ambulance Services Industry" means the industry that is | 4 | | comprised of "Qualifying Ground Ambulance Service Providers", | 5 | | as defined in this Section. | 6 | | "Qualifying Ground Ambulance Service Provider" means a | 7 | | "vehicle service provider," as that term is defined in Section | 8 | | 3.85 of the Emergency Medical Services (EMS) Systems Act, | 9 | | which operates licensed ambulances for the purpose of | 10 | | providing emergency, non-emergency ambulance services, or both | 11 | | emergency and non-emergency ambulance services. The term | 12 | | "Qualifying Ground Ambulance Service Provider" is limited to | 13 | | ambulance and EMS agencies that are privately held and | 14 | | nonprofit organizations headquartered within the State and | 15 | | licensed by the Department of Public Health as of March 12, | 16 | | 2020. | 17 | | "Eligible worker" means a staff member of a Qualifying | 18 | | Ground Ambulance Service Provider engaged in "essential work", | 19 | | as defined by Section 9901 of the ARPA and related federal | 20 | | guidance, and (1) whose total pay is below 150% of the average | 21 | | annual wage for all occupations in the worker's county of | 22 | | residence, as defined by the BLS Occupational Employment and | 23 | | Wage Statistics or (2) is not exempt from the federal Fair | 24 | | Labor Standards Act overtime provisions. | 25 | | (b) Purpose. The Department may receive federal funds | 26 | | under the authority of legislation passed in response to the |
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| 1 | | Coronavirus epidemic, including, but not limited to, the | 2 | | American Rescue Plan Act of 2021, P.L. 117-2 (the "ARPA"). | 3 | | Upon receipt or availability of such State or federal funds, | 4 | | and subject to appropriations for their use, the Department | 5 | | shall establish and administer programs for purposes allowable | 6 | | under Section 9901 of the ARPA to provide financial assistance | 7 | | to Qualifying Ground Ambulance Service Providers for premium | 8 | | pay for eligible workers, to provide reimbursement for | 9 | | eligible expenditures, and to provide support following the | 10 | | negative economic impact of the COVID-19 public health | 11 | | emergency on the Ambulance Services Industry. Financial | 12 | | assistance may include, but is not limited to, grants, expense | 13 | | reimbursements, or subsidies. | 14 | | (b-1) By December 31, 2022, the Department shall obtain | 15 | | appropriate documentation from Qualifying Ground Ambulance | 16 | | Service Providers to ascertain an accurate count of the number | 17 | | of licensed vehicles available to serve enrollees in the | 18 | | State's Medical Assistance Programs, which shall be known as | 19 | | the "total eligible vehicles". By February 28, 2023, | 20 | | Qualifying Ground Ambulance Service Providers shall be | 21 | | initially notified of their eligible award, which shall be the | 22 | | product of (i) the total amount of funds allocated under this | 23 | | Section and (ii) a quotient, the numerator of which is the | 24 | | number of licensed ground ambulance vehicles of an individual | 25 | | Qualifying Ground Ambulance Service Provider and the | 26 | | denominator of which is the total eligible vehicles. After |
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| 1 | | March 31, 2024, any unobligated funds shall be reallocated pro | 2 | | rata to the remaining Qualifying Ground Ambulance Service | 3 | | Providers that are able to prove up eligible expenses in | 4 | | excess of their initial award amount until all such | 5 | | appropriated funds are exhausted. | 6 | | Providers shall indicate to the Department what portion of | 7 | | their award they wish to allocate under the purposes outlined | 8 | | under paragraphs (d), (e), or (f), if applicable, of this | 9 | | Section. | 10 | | (c) Non-Emergency Service Certification. To be eligible | 11 | | for funding under this Section, a Qualifying Ground Ambulance | 12 | | Service Provider that provides non-emergency services to | 13 | | institutional residents must certify whether or not it is able | 14 | | to that it will provide non-emergency ambulance services to | 15 | | individuals enrolled in the State's Medical Assistance Program | 16 | | and residing in non-institutional settings for at least one | 17 | | year following the receipt of funding pursuant to this | 18 | | amendatory Act of the 102nd General Assembly. Certification | 19 | | indicating that a provider has such an ability does not mean | 20 | | that a provider is required to accept any or all requested | 21 | | transports. The provider shall maintain the certification in | 22 | | its records. The provider shall also maintain documentation of | 23 | | all non-emergency ambulance services for the period covered by | 24 | | the certification. The provider shall produce the | 25 | | certification and supporting documentation upon demand by the | 26 | | Department or its representative. Failure to comply shall |
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| 1 | | result in recovery of any payments made by the Department. | 2 | | (d) Premium Pay Initiative. Subject to paragraph (c) of | 3 | | this Section, the Department shall establish a Premium Pay | 4 | | Initiative to distribute awards to each Qualifying Ground | 5 | | Ambulance Service Provider for the purpose of providing | 6 | | premium 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. |
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| 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 | 10 | | paragraph (c) of this Section and based on an application | 11 | | filed by a Qualifying Ground Ambulance Service Provider, the | 12 | | Department shall establish the Ground Ambulance COVID-19 | 13 | | Response Support Initiative. The purpose of the award shall be | 14 | | to reimburse Qualifying Ground Ambulance Service Providers for | 15 | | eligible expenses under Section 9901 of the ARPA related to | 16 | | the public health impacts of the COVID-19 public health | 17 | | emergency, including , but not limited to : (i) costs incurred | 18 | | due to the COVID-19 public health emergency; (ii) costs | 19 | | related to vaccination programs, including vaccine incentives; | 20 | | (iii) costs related to COVID-19 testing; (iv) costs related to | 21 | | COVID-19 prevention and treatment equipment; (v) expenses for | 22 | | medical supplies; (vi) expenses for personal protective | 23 | | equipment; (vii) costs related to isolation and quarantine; | 24 | | (viii) costs for ventilation system installation and | 25 | | improvement; (ix) costs related to other emergency response | 26 | | equipment, such as ground ambulances, ventilators, cardiac |
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| 1 | | monitoring equipment, defibrillation equipment, pacing | 2 | | equipment, ambulance stretchers, and radio equipment; and (x) | 3 | | other emergency medical response expenses. costs related to | 4 | | COVID-19 testing for patients, COVID-19 prevention and | 5 | | treatment equipment, medical supplies, personal protective | 6 | | equipment, 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 | 25 | | designates the Ambulance Services Industry as an "impacted | 26 | | industry", as defined by the ARPA and related federal |
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| 1 | | guidance, the Department shall establish the Ambulance | 2 | | Industry Recovery Grant Program, to provide aid to Qualifying | 3 | | Ground Ambulance Service Providers that experienced staffing | 4 | | losses 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 | 19 | | long-term care
provider, beginning July 1, 2011 through June | 20 | | 30, 2022, or upon federal approval by the Centers for Medicare | 21 | | and Medicaid Services of the long-term care provider | 22 | | assessment described in subsection (a-1), whichever is later, | 23 | | an assessment is imposed upon each long-term care provider in | 24 | | an amount equal to $6.07 times the number of occupied bed days | 25 | | due and payable each month. Notwithstanding any provision of |
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| 1 | | any other Act to the
contrary, this assessment shall be | 2 | | construed as a tax, but shall not be billed or passed on to any | 3 | | resident of a nursing home operated by the nursing home | 4 | | provider.
| 5 | | (a-1) For the privilege of engaging in the occupation of | 6 | | long-term care provider for each occupied non-Medicare bed | 7 | | day, beginning July 1, 2022, an assessment is imposed upon | 8 | | each long-term care provider in an amount varying with the | 9 | | number of paid Medicaid resident days per annum in the | 10 | | facility with the following schedule of occupied bed tax | 11 | | amounts. This assessment is due and payable each month. The | 12 | | tax shall follow the schedule below and be rebased by the | 13 | | Department on an annual basis. The Department shall publish | 14 | | each facility's rebased tax rate according to the schedule in | 15 | | this Section 30 days prior to the beginning of the 6-month | 16 | | period beginning July 1, 2022 and thereafter 30 days prior to | 17 | | the beginning of each calendar year which shall incorporate | 18 | | the number of paid Medicaid days used to determine each | 19 | | facility'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 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 | 10 | | contrary, this assessment shall be construed as a tax but | 11 | | shall not be billed or passed on to any resident of a nursing | 12 | | home operated by the nursing home provider. | 13 | | For each new calendar year and for the 6-month period | 14 | | beginning July 1, 2022, a facility's paid Medicaid resident | 15 | | days per annum shall be determined using the Department's | 16 | | Medicaid Management Information System to include Medicaid | 17 | | resident days for the year ending 9 months earlier. | 18 | | (b) Nothing in this amendatory Act of 1992 shall be | 19 | | construed to
authorize any home rule unit or other unit of | 20 | | local government to license
for revenue or impose a tax or | 21 | | assessment upon long-term care providers or
the occupation of | 22 | | long-term care provider, or a tax or assessment measured
by | 23 | | the income or earnings or occupied bed days of a long-term care | 24 | | provider.
| 25 | | (c) The assessment imposed by this Section shall not be | 26 | | due and payable, however, until after the Department notifies |
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| 1 | | the long-term care providers, in writing, that the payment | 2 | | methodologies to long-term care providers required under | 3 | | Section 5-5.2 of this Code have been approved by the Centers | 4 | | for Medicare and Medicaid Services of the U.S. Department of | 5 | | Health and Human Services and that the waivers under 42 CFR | 6 | | 433.68 for the assessment imposed by this Section, if | 7 | | necessary, have been granted by the Centers for Medicare and | 8 | | Medicaid Services of the U.S. Department of Health and Human | 9 | | Services. | 10 | | (Source: P.A. 102-1035, eff. 5-31-22.)
| 11 | | Section 99. Effective date. This Act takes effect upon | 12 | | becoming law.".
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