Full Text of SB0110 102nd General Assembly
SB0110sam001 102ND GENERAL ASSEMBLY | Sen. Sara Feigenholtz Filed: 2/19/2021
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| 1 | | AMENDMENT TO SENATE BILL 110
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 110 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Public Aid Code is amended by | 5 | | changing Section 5-5.2 as follows:
| 6 | | (305 ILCS 5/5-5.2) (from Ch. 23, par. 5-5.2)
| 7 | | Sec. 5-5.2. Payment.
| 8 | | (a) All nursing facilities that are grouped pursuant to | 9 | | Section
5-5.1 of this Act shall receive the same rate of | 10 | | payment for similar
services.
| 11 | | (b) It shall be a matter of State policy that the Illinois | 12 | | Department
shall utilize a uniform billing cycle throughout | 13 | | the State for the
long-term care providers.
| 14 | | (c) Notwithstanding any other provisions of this Code, the | 15 | | methodologies for reimbursement of nursing services as | 16 | | provided under this Article shall no longer be applicable for |
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| 1 | | bills payable for nursing services rendered on or after a new | 2 | | reimbursement system based on the Resource Utilization Groups | 3 | | (RUGs) has been fully operationalized, which shall take effect | 4 | | for services provided on or after January 1, 2014. | 5 | | (d) The new nursing services reimbursement methodology | 6 | | utilizing RUG-IV 48 grouper model, which shall be referred to | 7 | | as the RUGs reimbursement system, taking effect January 1, | 8 | | 2014, shall be based on the following: | 9 | | (1) The methodology shall be resident-driven, | 10 | | facility-specific, and cost-based. | 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 1.0 . | 23 | | (4) Case mix index shall be assigned to each resident | 24 | | class based on the Centers for Medicare and Medicaid | 25 | | Services staff time measurement study in effect on July 1, | 26 | | 2013, utilizing an index maximization approach. |
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| 1 | | (5) The pool of funds available for distribution by | 2 | | case mix and the base facility rate shall be determined | 3 | | using the formula contained in subsection (d-1). | 4 | | (d-1) Calculation of base year Statewide RUG-IV nursing | 5 | | base per diem rate. | 6 | | (1) Base rate spending pool shall be: | 7 | | (A) The base year resident days which are | 8 | | calculated by multiplying the number of Medicaid | 9 | | residents in each nursing home as indicated in the MDS | 10 | | data defined in paragraph (4) by 365. | 11 | | (B) Each facility's nursing component per diem in | 12 | | effect on July 1, 2012 shall be multiplied by | 13 | | subsection (A). | 14 | | (C) Thirteen million is added to the product of | 15 | | subparagraph (A) and subparagraph (B) to adjust for | 16 | | the exclusion of nursing homes defined in paragraph | 17 | | (5). | 18 | | (2) For each nursing home with Medicaid residents as | 19 | | indicated by the MDS data defined in paragraph (4), | 20 | | weighted days adjusted for case mix and regional wage | 21 | | adjustment shall be calculated. For each home this | 22 | | calculation is the product of: | 23 | | (A) Base year resident days as calculated in | 24 | | subparagraph (A) of paragraph (1). | 25 | | (B) The nursing home's regional wage adjustor | 26 | | based on the Health Service Areas (HSA) groupings and |
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| 1 | | adjustors in effect on April 30, 2012. | 2 | | (C) Facility weighted case mix which is the number | 3 | | of Medicaid residents as indicated by the MDS data | 4 | | defined in paragraph (4) multiplied by the associated | 5 | | case weight for the RUG-IV 48 grouper model using | 6 | | standard RUG-IV procedures for index maximization. | 7 | | (D) The sum of the products calculated for each | 8 | | nursing home in subparagraphs (A) through (C) above | 9 | | shall be the base year case mix, rate adjusted | 10 | | weighted days. | 11 | | (3) The Statewide RUG-IV nursing base per diem rate: | 12 | | (A) on January 1, 2014 shall be the quotient of the | 13 | | paragraph (1) divided by the sum calculated under | 14 | | subparagraph (D) of paragraph (2); and | 15 | | (B) on and after July 1, 2014, shall be the amount | 16 | | calculated under subparagraph (A) of this paragraph | 17 | | (3) plus $1.76. | 18 | | (4) Minimum Data Set (MDS) comprehensive assessments | 19 | | for Medicaid residents on the last day of the quarter used | 20 | | to establish the base rate. | 21 | | (5) Nursing facilities designated as of July 1, 2012 | 22 | | by the Department as "Institutions for Mental Disease" | 23 | | shall be excluded from all calculations under this | 24 | | subsection. The data from these facilities shall not be | 25 | | used in the computations described in paragraphs (1) | 26 | | through (4) above to establish the base rate. |
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| 1 | | (e) Beginning July 1, 2014, the Department shall allocate | 2 | | funding in the amount up to $10,000,000 for per diem add-ons to | 3 | | the RUGS methodology for dates of service on and after July 1, | 4 | | 2014: | 5 | | (1) $0.63 for each resident who scores in I4200 | 6 | | Alzheimer's Disease or I4800 non-Alzheimer's Dementia. | 7 | | (2) $2.67 for each resident who scores either a "1" or | 8 | | "2" in any items S1200A through S1200I and also scores in | 9 | | RUG groups PA1, PA2, BA1, or BA2. | 10 | | (e-1) (Blank). | 11 | | (e-2) For dates of services beginning January 1, 2014, the | 12 | | RUG-IV nursing component per diem for a nursing home shall be | 13 | | the product of the statewide RUG-IV nursing base per diem | 14 | | rate, the facility average case mix index, and the regional | 15 | | wage adjustor. Transition rates for services provided between | 16 | | January 1, 2014 and December 31, 2014 shall be as follows: | 17 | | (1) The transition RUG-IV per diem nursing rate for | 18 | | nursing homes whose rate calculated in this subsection | 19 | | (e-2) is greater than the nursing component rate in effect | 20 | | July 1, 2012 shall be paid the sum of: | 21 | | (A) The nursing component rate in effect July 1, | 22 | | 2012; plus | 23 | | (B) The difference of the RUG-IV nursing component | 24 | | per diem calculated for the current quarter minus the | 25 | | nursing component rate in effect July 1, 2012 | 26 | | multiplied by 0.88. |
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| 1 | | (2) The transition RUG-IV per diem nursing rate for | 2 | | nursing homes whose rate calculated in this subsection | 3 | | (e-2) is less than the nursing component rate in effect | 4 | | July 1, 2012 shall be paid the sum of: | 5 | | (A) The nursing component rate in effect July 1, | 6 | | 2012; plus | 7 | | (B) The difference of the RUG-IV nursing component | 8 | | per diem calculated for the current quarter minus the | 9 | | nursing component rate in effect July 1, 2012 | 10 | | multiplied by 0.13. | 11 | | (f) Notwithstanding any other provision of this Code, on | 12 | | and after July 1, 2012, reimbursement rates associated with | 13 | | the nursing or support components of the current nursing | 14 | | facility rate methodology shall not increase beyond the level | 15 | | effective May 1, 2011 until a new reimbursement system based | 16 | | on the RUGs IV 48 grouper model has been fully | 17 | | operationalized. | 18 | | (g) Notwithstanding any other provision of this Code, on | 19 | | and after July 1, 2012, for facilities not designated by the | 20 | | Department of Healthcare and Family Services as "Institutions | 21 | | for Mental Disease", rates effective May 1, 2011 shall be | 22 | | adjusted as follows: | 23 | | (1) Individual nursing rates for residents classified | 24 | | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | 25 | | ending March 31, 2012 shall be reduced by 10%; | 26 | | (2) Individual nursing rates for residents classified |
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| 1 | | in all other RUG IV groups shall be reduced by 1.0%; | 2 | | (3) Facility rates for the capital and support | 3 | | components shall be reduced by 1.7%. | 4 | | (h) Notwithstanding any other provision of this Code, on | 5 | | and after July 1, 2012, nursing facilities designated by the | 6 | | Department of Healthcare and Family Services as "Institutions | 7 | | for Mental Disease" and "Institutions for Mental Disease" that | 8 | | are facilities licensed under the Specialized Mental Health | 9 | | Rehabilitation Act of 2013 shall have the nursing, | 10 | | socio-developmental, capital, and support components of their | 11 | | reimbursement rate effective May 1, 2011 reduced in total by | 12 | | 2.7%. | 13 | | (i) On and after July 1, 2014, the reimbursement rates for | 14 | | the support component of the nursing facility rate for | 15 | | facilities licensed under the Nursing Home Care Act as skilled | 16 | | or intermediate care facilities shall be the rate in effect on | 17 | | June 30, 2014 increased by 8.17%. | 18 | | (j) Notwithstanding any other provision of law, subject to | 19 | | federal approval, effective July 1, 2019, sufficient funds | 20 | | shall be allocated for changes to rates for facilities | 21 | | licensed under the Nursing Home Care Act as skilled nursing | 22 | | facilities or intermediate care facilities for dates of | 23 | | services on and after July 1, 2019: (i) to establish a per diem | 24 | | add-on to the direct care per diem rate not to exceed | 25 | | $70,000,000 annually in the aggregate taking into account | 26 | | federal matching funds for the purpose of addressing the |
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| 1 | | facility's unique staffing needs, adjusted quarterly and | 2 | | distributed by a weighted formula based on Medicaid bed days | 3 | | on the last day of the second quarter preceding the quarter for | 4 | | which the rate is being adjusted; and (ii) in an amount not to | 5 | | exceed $170,000,000 annually in the aggregate taking into | 6 | | account federal matching funds to permit the support component | 7 | | of the nursing facility rate to be updated as follows: | 8 | | (1) 80%, or $136,000,000, of the funds shall be used | 9 | | to update each facility's rate in effect on June 30, 2019 | 10 | | using the most recent cost reports on file, which have had | 11 | | a limited review conducted by the Department of Healthcare | 12 | | and Family Services and will not hold up enacting the rate | 13 | | increase, with the Department of Healthcare and Family | 14 | | Services and taking into account subsection (i). | 15 | | (2) After completing the calculation in paragraph (1), | 16 | | any facility whose rate is less than the rate in effect on | 17 | | June 30, 2019 shall have its rate restored to the rate in | 18 | | effect on June 30, 2019 from the 20% of the funds set | 19 | | aside. | 20 | | (3) The remainder of the 20%, or $34,000,000, shall be | 21 | | used to increase each facility's rate by an equal | 22 | | percentage. | 23 | | To implement item (i) in this subsection, facilities shall | 24 | | file quarterly reports documenting compliance with its | 25 | | annually approved staffing plan, which shall permit compliance | 26 | | with Section 3-202.05 of the Nursing Home Care Act. A facility |
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| 1 | | that fails to meet the benchmarks and dates contained in the | 2 | | plan may have its add-on adjusted in the quarter following the | 3 | | quarterly review. Nothing in this Section shall limit the | 4 | | ability of the facility to appeal a ruling of non-compliance | 5 | | and a subsequent reduction to the add-on. Funds adjusted for | 6 | | noncompliance shall be maintained in the Long-Term Care | 7 | | Provider Fund and accounted for separately. At the end of each | 8 | | fiscal year, these funds shall be made available to facilities | 9 | | for special staffing projects. | 10 | | In order to provide for the expeditious and timely
| 11 | | implementation of the provisions of Public Act 101-10 this | 12 | | amendatory Act of the
101st General Assembly , emergency rules | 13 | | to implement any provision of Public Act 101-10 this | 14 | | amendatory Act of the 101st General Assembly may be adopted in | 15 | | accordance with this subsection by the agency charged with | 16 | | administering that provision or
initiative. The agency shall | 17 | | simultaneously file emergency rules and permanent rules to | 18 | | ensure that there is no interruption in administrative | 19 | | guidance. The 150-day limitation of the effective period of | 20 | | emergency rules does not apply to rules adopted under this
| 21 | | subsection, and the effective period may continue through
June | 22 | | 30, 2021. The 24-month limitation on the adoption of
emergency | 23 | | rules does not apply to rules adopted under this
subsection. | 24 | | The adoption of emergency rules authorized by this subsection | 25 | | is deemed to be necessary for the public interest, safety, and | 26 | | welfare. |
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| 1 | | (k) (j) During the first quarter of State Fiscal Year | 2 | | 2020, the Department of Healthcare of Family Services must | 3 | | convene a technical advisory group consisting of members of | 4 | | all trade associations representing Illinois skilled nursing | 5 | | providers to discuss changes necessary with federal | 6 | | implementation of Medicare's Patient-Driven Payment Model. | 7 | | Implementation of Medicare's Patient-Driven Payment Model | 8 | | shall, by September 1, 2020, end the collection of the MDS data | 9 | | that is necessary to maintain the current RUG-IV Medicaid | 10 | | payment methodology. The technical advisory group must | 11 | | consider a revised reimbursement methodology that takes into | 12 | | account transparency, accountability, actual staffing as | 13 | | reported under the federally required Payroll Based Journal | 14 | | system, changes to the minimum wage, adequacy in coverage of | 15 | | the cost of care, and a quality component that rewards quality | 16 | | improvements. | 17 | | (Source: P.A. 101-10, eff. 6-5-19; 101-348, eff. 8-9-19; | 18 | | revised 9-18-19.)
| 19 | | Section 99. Effective date. This Act takes effect upon | 20 | | becoming law.".
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