Full Text of SB2475 093rd General Assembly
SB2475 93RD GENERAL ASSEMBLY
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93RD GENERAL ASSEMBLY
State of Illinois
2003 and 2004 SB2475
Introduced 2/3/2004, by Dan Rutherford 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. In provisions concerning Medicaid rates
for nursing homes, provides that for FY04 and for each subsequent fiscal year
until the rates for such facilities equal the level in effect on June 30, 2002,
all moneys appropriated specifically for Medicaid rate adjustments for such
facilities shall be applied first to restoring
the rates for nursing homes to the level in
effect on June 30, 2002, thereby restoring the 5.9% reduction in rates
otherwise required;
requires moneys appropriated specifically for rate adjustments in excess of the amount necessary to restore the rates to be applied to making payments in accordance with the new Minimum Data Set (MDS) methodology. Provides that on and after July 1, 2005, such excess moneys shall be applied as follows: (i) 50% shall be applied to
making payments to facilities in accordance with the new MDS-based payment
methodology; and (ii) 50% shall be
applied to provide an equitable percentage increase in the nursing component of
the
nursing home rates. Provides that on and after July 1, 2005, the rates paid to
nursing homes shall not be reduced to an amount less than 9.5% of the nursing rate in
effect
on June 30, 2002. Effective immediately.
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A BILL FOR
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SB2475 |
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SRS093 00166 GLC 40036 b |
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| AN ACT in relation to public aid.
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| Be it enacted by the People of the State of Illinois, | 3 |
| represented in the General Assembly:
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| Section 5. The Illinois Public Aid Code is amended by
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| changing Section 5-5.4 as follows:
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| (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 Public | 8 |
| Aid.
The Department of Public Aid shall develop standards of | 9 |
| payment of skilled
nursing and intermediate care services in | 10 |
| facilities providing such services
under this 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 | 13 |
| prospective basis.
The amount of the payment rate for all | 14 |
| nursing facilities certified by the
Department of Public Health | 15 |
| under the Nursing Home Care Act as Intermediate
Care for the | 16 |
| Developmentally Disabled facilities, Long Term Care for Under | 17 |
| Age
22 facilities, Skilled Nursing facilities, or Intermediate | 18 |
| Care facilities
under the
medical assistance program shall be | 19 |
| prospectively established annually on the
basis of historical, | 20 |
| financial, and statistical data reflecting actual costs
from | 21 |
| prior years, which shall be applied to the current rate year | 22 |
| and updated
for inflation, except that the capital cost element | 23 |
| for newly constructed
facilities shall be based upon projected | 24 |
| budgets. The annually established
payment rate shall take | 25 |
| effect on July 1 in 1984 and subsequent years. No rate
increase | 26 |
| and no
update for inflation shall be provided on or after July | 27 |
| 1, 1994 and before
July 1, 2004, unless specifically provided | 28 |
| for in this
Section.
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| For facilities licensed by the Department of Public Health | 30 |
| under the Nursing
Home Care Act as Intermediate Care for the | 31 |
| Developmentally Disabled facilities
or Long Term Care for Under | 32 |
| Age 22 facilities, the rates taking effect on July
1, 1998 |
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SRS093 00166 GLC 40036 b |
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| 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 | 3 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 4 |
| the rates taking effect on July 1,
1998 shall include an | 5 |
| increase of 3% plus $1.10 per resident-day, as defined by
the | 6 |
| Department.
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| For facilities licensed by the Department of Public Health | 8 |
| under the
Nursing Home Care Act as Intermediate Care for the | 9 |
| Developmentally Disabled
facilities or Long Term Care for Under | 10 |
| Age 22 facilities, the rates taking
effect on July 1, 1999 | 11 |
| shall include an increase of 1.6% plus $3.00 per
resident-day, | 12 |
| 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 | 14 |
| Skilled Nursing
facilities or Intermediate Care facilities, | 15 |
| the rates taking effect on July 1,
1999 shall include an | 16 |
| increase of 1.6% and, for services provided on or after
October | 17 |
| 1, 1999, shall be increased by $4.00 per resident-day, as | 18 |
| defined by
the Department.
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| For facilities licensed by the Department of Public Health | 20 |
| under the
Nursing Home Care Act as Intermediate Care for the | 21 |
| Developmentally Disabled
facilities or Long Term Care for Under | 22 |
| Age 22 facilities, the rates taking
effect on July 1, 2000 | 23 |
| shall include an increase of 2.5% per resident-day,
as defined | 24 |
| by the Department. For facilities licensed by the Department of
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| Public Health under the Nursing Home Care Act as Skilled | 26 |
| Nursing facilities or
Intermediate Care facilities, the rates | 27 |
| taking effect on July 1, 2000 shall
include an increase of 2.5% | 28 |
| per resident-day, as defined by the Department.
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| For facilities licensed by the Department of Public Health | 30 |
| under the
Nursing Home Care Act as skilled nursing facilities | 31 |
| or intermediate care
facilities, a new payment methodology must | 32 |
| be implemented for the nursing
component of the rate effective | 33 |
| July 1, 2003. The Department of Public Aid
shall develop the | 34 |
| new payment methodology using the Minimum Data Set
(MDS) as the | 35 |
| instrument to collect information concerning nursing home
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| resident condition necessary to compute the rate. The |
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SB2475 |
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SRS093 00166 GLC 40036 b |
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| Department of Public Aid
shall develop the new payment | 2 |
| methodology to meet the unique needs of
Illinois nursing home | 3 |
| residents while remaining subject to the appropriations
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| provided by the General Assembly.
A transition period from the | 5 |
| payment methodology in effect on June 30, 2003
to the payment | 6 |
| methodology in effect on July 1, 2003 shall be provided for a
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| period not exceeding 2 years after implementation of the new | 8 |
| payment
methodology as follows:
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| (A) For a facility that would receive a lower
nursing | 10 |
| component rate per patient day under the new system than | 11 |
| the facility
received
effective on the date immediately | 12 |
| preceding the date that the Department
implements the new | 13 |
| payment methodology, the nursing component rate per | 14 |
| patient
day for the facility
shall be held at
the level in | 15 |
| effect on the date immediately preceding the date that the
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| Department implements the new payment methodology until a | 17 |
| higher nursing
component rate of
reimbursement is achieved | 18 |
| by that
facility.
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| (B) For a facility that would receive a higher nursing | 20 |
| component rate per
patient day under the payment | 21 |
| methodology in effect on July 1, 2003 than the
facility | 22 |
| received effective on the date immediately preceding the | 23 |
| date that the
Department implements the new payment | 24 |
| methodology, the nursing component rate
per patient day for | 25 |
| the facility shall be adjusted.
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| (C) Notwithstanding paragraphs (A) and (B), the | 27 |
| nursing component rate per
patient day for the facility | 28 |
| shall be adjusted subject to appropriations
provided by the | 29 |
| General Assembly.
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| For facilities licensed by the Department of Public Health | 31 |
| under the
Nursing Home Care Act as Intermediate Care for the | 32 |
| Developmentally Disabled
facilities or Long Term Care for Under | 33 |
| Age 22 facilities, the rates taking
effect on March 1, 2001 | 34 |
| shall include a statewide increase of 7.85%, as
defined by the | 35 |
| Department.
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| For facilities licensed by the Department of Public Health |
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SRS093 00166 GLC 40036 b |
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| under the
Nursing Home Care Act as Intermediate Care for the | 2 |
| Developmentally Disabled
facilities or Long Term Care for Under | 3 |
| Age 22 facilities, the rates taking
effect on April 1, 2002 | 4 |
| shall include a statewide increase of 2.0%, as
defined by the | 5 |
| Department.
This increase terminates on July 1, 2002;
beginning | 6 |
| 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 | 9 |
| under the
Nursing Home Care Act as skilled nursing facilities | 10 |
| or intermediate care
facilities, the rates taking effect on | 11 |
| July 1, 2001 shall be computed using the most recent cost | 12 |
| reports
on file with the Department of Public Aid no later than | 13 |
| April 1, 2000,
updated for inflation to January 1, 2001. For | 14 |
| rates effective July 1, 2001
only, rates shall be the greater | 15 |
| of the rate computed for July 1, 2001
or the rate effective on | 16 |
| June 30, 2001.
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| Notwithstanding any other provision of this Section, for | 18 |
| facilities
licensed by the Department of Public Health under | 19 |
| the Nursing Home Care Act
as skilled nursing facilities or | 20 |
| intermediate care facilities, the Illinois
Department shall | 21 |
| 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, | 23 |
| 2002.
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| Rates established effective each July 1 shall govern | 25 |
| payment
for services rendered throughout that fiscal year, | 26 |
| except that rates
established on July 1, 1996 shall be | 27 |
| increased by 6.8% for services
provided on or after January 1, | 28 |
| 1997. Such rates will be based
upon the rates calculated for | 29 |
| the year beginning July 1, 1990, and for
subsequent years | 30 |
| thereafter until June 30, 2001 shall be based on the
facility | 31 |
| cost reports
for the facility fiscal year ending at any point | 32 |
| in time during the previous
calendar year, updated to the | 33 |
| midpoint of the rate year. The cost report
shall be on file | 34 |
| with the Department no later than April 1 of the current
rate | 35 |
| year. Should the cost report not be on file by April 1, the | 36 |
| Department
shall base the rate on the latest cost report filed |
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SRS093 00166 GLC 40036 b |
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| by each skilled care
facility and intermediate care facility, | 2 |
| updated to the midpoint of the
current rate year. In | 3 |
| determining rates for services rendered on and after
July 1, | 4 |
| 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 | 6 |
| would reduce
any component of the Medicaid rate to a level | 7 |
| below what that component would
have been utilizing in the rate | 8 |
| effective on July 1, 1984.
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| For the State fiscal year beginning July 1, 2003 and for | 10 |
| each subsequent fiscal year until the rates for skilled nursing | 11 |
| facilities and intermediate care facilities licensed by the | 12 |
| Department of Public Health equal the level in effect on June | 13 |
| 30, 2002, all moneys appropriated specifically for rate | 14 |
| adjustments for such facilities in connection with the program | 15 |
| of medical assistance under this Article V shall be applied | 16 |
| first to restoring the rates to the level in effect on June 30, | 17 |
| 2002. For the State fiscal year beginning July 1, 2003, any | 18 |
| moneys appropriated specifically for rate adjustments in | 19 |
| excess of the amount necessary to restore the 5.9% reduction in | 20 |
| rates otherwise required under this Section shall be applied to | 21 |
| making payments to facilities in accordance with the MDS-based | 22 |
| payment methodology until July 1, 2005.
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| On and after July 1, 2005, any moneys appropriated | 24 |
| specifically for rate adjustments shall first be used to | 25 |
| restore the nursing rate to the level in effect on June 30, | 26 |
| 2002. All moneys appropriated specifically for rate | 27 |
| adjustments in excess of the amount necessary to restore the | 28 |
| 5.9% reduction in rates otherwise required under this Section | 29 |
| shall be applied as follows: (i) 50% shall be applied to making | 30 |
| payments to facilities in accordance with the MDS-based payment | 31 |
| methodology required under this Section; and (ii) 50% shall be | 32 |
| applied to provide an equitable percentage increase in the | 33 |
| nursing component of the rates for all skilled nursing | 34 |
| facilities and intermediate care facilities licensed by the | 35 |
| Department of Public Health.
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| Notwithstanding any other provision of this Section, on and |
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SB2475 |
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SRS093 00166 GLC 40036 b |
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| after July 1, 2005, the rates paid to skilled nursing | 2 |
| facilities and intermediate care facilities licensed by the | 3 |
| Department of Public Health shall not be reduced to an amount | 4 |
| less than 9.5% of the nursing rate in effect on June 30, 2002.
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| (2) Shall take into account the actual costs incurred by | 6 |
| facilities
in providing services for recipients of skilled | 7 |
| nursing and intermediate
care services under the medical | 8 |
| 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 | 12 |
| facilities in
meeting licensing and certification standards | 13 |
| imposed and prescribed by the
State of Illinois, any of its | 14 |
| political subdivisions or municipalities and by
the U.S. | 15 |
| Department of Health and Human Services pursuant to Title XIX | 16 |
| of the
Social Security Act.
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| The Department of Public Aid shall develop precise | 18 |
| standards for
payments to reimburse nursing facilities for any | 19 |
| utilization of
appropriate rehabilitative personnel for the | 20 |
| provision of rehabilitative
services which is authorized by | 21 |
| federal regulations, including
reimbursement for services | 22 |
| provided by qualified therapists or qualified
assistants, and | 23 |
| which is in accordance with accepted professional
practices. | 24 |
| Reimbursement also may be made for utilization of other
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| supportive personnel under appropriate supervision.
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| (Source: P.A. 92-10, eff. 6-11-01;
92-31, eff. 6-28-01; 92-597, | 27 |
| eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff.
1-1-03; 93-20, | 28 |
| eff. 6-20-03.)
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| Section 99. Effective date. This Act takes effect upon | 30 |
| becoming law.
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