Full Text of SB2433 94th General Assembly
SB2433 94TH GENERAL ASSEMBLY
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94TH GENERAL ASSEMBLY
State of Illinois
2005 and 2006 SB2433
Introduced 1/18/2006, by Sen. Don Harmon SYNOPSIS AS INTRODUCED: |
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305 ILCS 5/5-5.4 |
from Ch. 23, par. 5-5.4 |
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Amends the Illinois Public Aid Code. Makes a technical changes in a Section concerning standards of payment of skilled
nursing and intermediate care services.
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A BILL FOR
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SB2433 |
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LRB094 16314 DRJ 51563 b |
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| AN ACT concerning public aid.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Public Aid Code is amended by | 5 |
| changing Section 5-5.4 as follows: | 6 |
| (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
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| Sec. 5-5.4. Standards of Payment - Department of Healthcare | 8 |
| and Family Services
Public Aid .
The
The Department of | 9 |
| Healthcare and Family Services
Public Aid shall develop | 10 |
| standards of payment of skilled
nursing and intermediate care | 11 |
| services in facilities providing such services
under this | 12 |
| Article which:
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| (1) Provide for the determination of a facility's payment
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| for skilled nursing and intermediate care services on a | 15 |
| prospective basis.
The amount of the payment rate for all | 16 |
| nursing facilities certified by the
Department of Public Health | 17 |
| under the Nursing Home Care Act as Intermediate
Care for the | 18 |
| Developmentally Disabled facilities, Long Term Care for Under | 19 |
| Age
22 facilities, Skilled Nursing facilities, or Intermediate | 20 |
| Care facilities
under the
medical assistance program shall be | 21 |
| prospectively established annually on the
basis of historical, | 22 |
| financial, and statistical data reflecting actual costs
from | 23 |
| prior years, which shall be applied to the current rate year | 24 |
| and updated
for inflation, except that the capital cost element | 25 |
| for newly constructed
facilities shall be based upon projected | 26 |
| budgets. The annually established
payment rate shall take | 27 |
| effect on July 1 in 1984 and subsequent years. No rate
increase | 28 |
| and no
update for inflation shall be provided on or after July | 29 |
| 1, 1994 and before
July 1, 2006, unless specifically provided | 30 |
| for in this
Section.
The changes made by this amendatory Act of | 31 |
| the 93rd General Assembly extending the duration of the | 32 |
| prohibition against a rate increase or update for inflation are |
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SB2433 |
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LRB094 16314 DRJ 51563 b |
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| effective retroactive to July 1, 2004.
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| For facilities licensed by the Department of Public Health | 3 |
| under the Nursing
Home Care Act as Intermediate Care for the | 4 |
| Developmentally Disabled facilities
or Long Term Care for Under | 5 |
| Age 22 facilities, the rates taking effect on July
1, 1998 | 6 |
| shall include an increase of 3%. For facilities licensed by the
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| Department of Public Health under the Nursing Home Care Act as | 8 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 9 |
| the rates taking effect on July 1,
1998 shall include an | 10 |
| increase of 3% plus $1.10 per resident-day, as defined by
the | 11 |
| Department. For facilities licensed by the Department of Public | 12 |
| Health under the Nursing Home Care Act as Intermediate Care | 13 |
| Facilities for the Developmentally Disabled or Long Term Care | 14 |
| for Under Age 22 facilities, the rates taking effect on January | 15 |
| 1, 2006 shall include an increase of 3%.
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| For facilities licensed by the Department of Public Health | 17 |
| under the
Nursing Home Care Act as Intermediate Care for the | 18 |
| Developmentally Disabled
facilities or Long Term Care for Under | 19 |
| Age 22 facilities, the rates taking
effect on July 1, 1999 | 20 |
| shall include an increase of 1.6% plus $3.00 per
resident-day, | 21 |
| as defined by the Department. For facilities licensed by the
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| Department of Public Health under the Nursing Home Care Act as | 23 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 24 |
| the rates taking effect on July 1,
1999 shall include an | 25 |
| increase of 1.6% and, for services provided on or after
October | 26 |
| 1, 1999, shall be increased by $4.00 per resident-day, as | 27 |
| defined by
the Department.
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| For facilities licensed by the Department of Public Health | 29 |
| under the
Nursing Home Care Act as Intermediate Care for the | 30 |
| Developmentally Disabled
facilities or Long Term Care for Under | 31 |
| Age 22 facilities, the rates taking
effect on July 1, 2000 | 32 |
| shall include an increase of 2.5% per resident-day,
as defined | 33 |
| by the Department. For facilities licensed by the Department of
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| Public Health under the Nursing Home Care Act as Skilled | 35 |
| Nursing facilities or
Intermediate Care facilities, the rates | 36 |
| taking effect on July 1, 2000 shall
include an increase of 2.5% |
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| per resident-day, as defined by the Department.
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| For facilities licensed by the Department of Public Health | 3 |
| under the
Nursing Home Care Act as skilled nursing facilities | 4 |
| or intermediate care
facilities, a new payment methodology must | 5 |
| be implemented for the nursing
component of the rate effective | 6 |
| July 1, 2003. The Department of Public Aid
(now Healthcare and | 7 |
| Family Services) shall develop the new payment methodology | 8 |
| using the Minimum Data Set
(MDS) as the instrument to collect | 9 |
| information concerning nursing home
resident condition | 10 |
| necessary to compute the rate. The Department of Public Aid
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| shall develop the new payment methodology to meet the unique | 12 |
| needs of
Illinois nursing home residents while remaining | 13 |
| subject to the appropriations
provided by the General Assembly.
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| A transition period from the payment methodology in effect on | 15 |
| June 30, 2003
to the payment methodology in effect on July 1, | 16 |
| 2003 shall be provided for a
period not exceeding 3 years after | 17 |
| implementation of the new payment
methodology as follows:
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| (A) For a facility that would receive a lower
nursing | 19 |
| component rate per patient day under the new system than | 20 |
| the facility
received
effective on the date immediately | 21 |
| preceding the date that the Department
implements the new | 22 |
| payment methodology, the nursing component rate per | 23 |
| patient
day for the facility
shall be held at
the level in | 24 |
| effect on the date immediately preceding the date that the
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| Department implements the new payment methodology until a | 26 |
| higher nursing
component rate of
reimbursement is achieved | 27 |
| by that
facility.
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| (B) For a facility that would receive a higher nursing | 29 |
| component rate per
patient day under the payment | 30 |
| methodology in effect on July 1, 2003 than the
facility | 31 |
| received effective on the date immediately preceding the | 32 |
| date that the
Department implements the new payment | 33 |
| methodology, the nursing component rate
per patient day for | 34 |
| the facility shall be adjusted.
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| (C) Notwithstanding paragraphs (A) and (B), the | 36 |
| nursing component rate per
patient day for the facility |
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| shall be adjusted subject to appropriations
provided by the | 2 |
| General Assembly.
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| For facilities licensed by the Department of Public Health | 4 |
| under the
Nursing Home Care Act as Intermediate Care for the | 5 |
| Developmentally Disabled
facilities or Long Term Care for Under | 6 |
| Age 22 facilities, the rates taking
effect on March 1, 2001 | 7 |
| shall include a statewide increase of 7.85%, as
defined by the | 8 |
| Department.
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| For facilities licensed by the Department of Public Health | 10 |
| under the
Nursing Home Care Act as Intermediate Care for the | 11 |
| Developmentally Disabled
facilities or Long Term Care for Under | 12 |
| Age 22 facilities, the rates taking
effect on April 1, 2002 | 13 |
| shall include a statewide increase of 2.0%, as
defined by the | 14 |
| Department.
This increase terminates on July 1, 2002;
beginning | 15 |
| July 1, 2002 these rates are reduced to the level of the rates
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| in effect on March 31, 2002, as defined by the Department.
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| For facilities licensed by the Department of Public Health | 18 |
| under the
Nursing Home Care Act as skilled nursing facilities | 19 |
| or intermediate care
facilities, the rates taking effect on | 20 |
| July 1, 2001 shall be computed using the most recent cost | 21 |
| reports
on file with the Department of Public Aid no later than | 22 |
| April 1, 2000,
updated for inflation to January 1, 2001. For | 23 |
| rates effective July 1, 2001
only, rates shall be the greater | 24 |
| of the rate computed for July 1, 2001
or the rate effective on | 25 |
| June 30, 2001.
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| Notwithstanding any other provision of this Section, for | 27 |
| facilities
licensed by the Department of Public Health under | 28 |
| the Nursing Home Care Act
as skilled nursing facilities or | 29 |
| intermediate care facilities, the Illinois
Department shall | 30 |
| determine by rule the rates taking effect on July 1, 2002,
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| which shall be 5.9% less than the rates in effect on June 30, | 32 |
| 2002.
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| Notwithstanding any other provision of this Section, for | 34 |
| facilities
licensed by the Department of Public Health under | 35 |
| the Nursing Home Care Act as
skilled nursing
facilities or | 36 |
| intermediate care facilities, if the payment methodologies |
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| required under Section 5A-12 and the waiver granted under 42 | 2 |
| CFR 433.68 are approved by the United States Centers for | 3 |
| Medicare and Medicaid Services, the rates taking effect on July | 4 |
| 1, 2004 shall be 3.0% greater than the rates in effect on June | 5 |
| 30, 2004. These rates shall take
effect only upon approval and
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| implementation of the payment methodologies required under | 7 |
| Section 5A-12.
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| Notwithstanding any other provisions of this Section, for | 9 |
| facilities licensed by the Department of Public Health under | 10 |
| the Nursing Home Care Act as skilled nursing facilities or | 11 |
| intermediate care facilities, the rates taking effect on | 12 |
| January 1, 2005 shall be 3% more than the rates in effect on | 13 |
| December 31, 2004.
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| For facilities
licensed
by the
Department of Public Health | 15 |
| under the Nursing Home Care Act as Intermediate
Care for
the | 16 |
| Developmentally Disabled facilities or as long-term care | 17 |
| facilities for
residents under 22 years of age, the rates | 18 |
| taking effect on July 1,
2003 shall
include a statewide | 19 |
| increase of 4%, as defined by the Department.
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| Notwithstanding any other provision of this Section, for | 21 |
| facilities licensed by the Department of Public Health under | 22 |
| the Nursing Home Care Act as skilled nursing facilities or | 23 |
| intermediate care facilities, effective January 1, 2005, | 24 |
| facility rates shall be increased by the difference between (i) | 25 |
| a facility's per diem property, liability, and malpractice | 26 |
| insurance costs as reported in the cost report filed with the | 27 |
| Department of Public Aid and used to establish rates effective | 28 |
| July 1, 2001 and (ii) those same costs as reported in the | 29 |
| facility's 2002 cost report. These costs shall be passed | 30 |
| through to the facility without caps or limitations, except for | 31 |
| adjustments required under normal auditing procedures.
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| Rates established effective each July 1 shall govern | 33 |
| payment
for services rendered throughout that fiscal year, | 34 |
| except that rates
established on July 1, 1996 shall be | 35 |
| increased by 6.8% for services
provided on or after January 1, | 36 |
| 1997. Such rates will be based
upon the rates calculated for |
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| the year beginning July 1, 1990, and for
subsequent years | 2 |
| thereafter until June 30, 2001 shall be based on the
facility | 3 |
| cost reports
for the facility fiscal year ending at any point | 4 |
| in time during the previous
calendar year, updated to the | 5 |
| midpoint of the rate year. The cost report
shall be on file | 6 |
| with the Department no later than April 1 of the current
rate | 7 |
| year. Should the cost report not be on file by April 1, the | 8 |
| Department
shall base the rate on the latest cost report filed | 9 |
| by each skilled care
facility and intermediate care facility, | 10 |
| updated to the midpoint of the
current rate year. In | 11 |
| determining rates for services rendered on and after
July 1, | 12 |
| 1985, fixed time shall not be computed at less than zero. The
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| Department shall not make any alterations of regulations which | 14 |
| would reduce
any component of the Medicaid rate to a level | 15 |
| below what that component would
have been utilizing in the rate | 16 |
| effective on July 1, 1984.
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| (2) Shall take into account the actual costs incurred by | 18 |
| facilities
in providing services for recipients of skilled | 19 |
| nursing and intermediate
care services under the medical | 20 |
| assistance program.
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| (3) Shall take into account the medical and psycho-social
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| characteristics and needs of the patients.
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| (4) Shall take into account the actual costs incurred by | 24 |
| facilities in
meeting licensing and certification standards | 25 |
| imposed and prescribed by the
State of Illinois, any of its | 26 |
| political subdivisions or municipalities and by
the U.S. | 27 |
| Department of Health and Human Services pursuant to Title XIX | 28 |
| of the
Social Security Act.
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| The Department of Healthcare and Family Services
Public Aid | 30 |
| shall develop precise standards for
payments to reimburse | 31 |
| nursing facilities for any utilization of
appropriate | 32 |
| rehabilitative personnel for the provision of rehabilitative
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| services which is authorized by federal regulations, including
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| reimbursement for services provided by qualified therapists or | 35 |
| qualified
assistants, and which is in accordance with accepted | 36 |
| professional
practices. Reimbursement also may be made for |
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| utilization of other
supportive personnel under appropriate | 2 |
| supervision.
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| (Source: P.A. 93-20, eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, | 4 |
| eff. 2-3-04; 93-841, eff. 7-30-04; 93-1087, eff. 2-28-05; | 5 |
| 94-48, eff. 7-1-05; 94-85, eff. 6-28-05; 94-697, eff. 11-21-05; | 6 |
| revised 12-15-05.)
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