Full Text of HB3037 101st General Assembly
HB3037 101ST GENERAL ASSEMBLY |
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020 HB3037 Introduced , by Rep. Michael D. Unes SYNOPSIS AS INTRODUCED: |
| 305 ILCS 5/5-5.2 | from Ch. 23, par. 5-5.2 |
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Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to make all room and board payments directly to long-term care providers and all hospice care payments directly to hospice care providers whenever recipients of medical assistance opt to receive hospice care at long-term care facilities.
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| | | FISCAL NOTE ACT MAY APPLY | |
| | A BILL FOR |
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| 1 | | AN ACT concerning public aid.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 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 the | 13 | | State for the
long-term care providers. Notwithstanding any | 14 | | other provision of law, whenever a recipient of medical | 15 | | assistance opts to receive hospice care at a long-term care | 16 | | facility, the Department shall make all room and board payments | 17 | | directly to the long-term care provider and all hospice care | 18 | | payments directly to the hospice care provider.
| 19 | | (c) Notwithstanding any other provisions of this Code, the | 20 | | methodologies for reimbursement of nursing services as | 21 | | provided under this Article shall no longer be applicable for | 22 | | bills payable for nursing services rendered on or after a new | 23 | | reimbursement system based on the Resource Utilization Groups |
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| 1 | | (RUGs) has been fully operationalized, which shall take effect | 2 | | for services provided on or after January 1, 2014. | 3 | | (d) The new nursing services reimbursement methodology | 4 | | utilizing RUG-IV 48 grouper model, which shall be referred to | 5 | | as the RUGs reimbursement system, taking effect January 1, | 6 | | 2014, shall be based on the following: | 7 | | (1) The methodology shall be resident-driven, | 8 | | facility-specific, and cost-based. | 9 | | (2) Costs shall be annually rebased and case mix index | 10 | | quarterly updated. The nursing services methodology will | 11 | | be assigned to the Medicaid enrolled residents on record as | 12 | | of 30 days prior to the beginning of the rate period in the | 13 | | Department's Medicaid Management Information System (MMIS) | 14 | | as present on the last day of the second quarter preceding | 15 | | the rate period based upon the Assessment Reference Date of | 16 | | the Minimum Data Set (MDS). | 17 | | (3) Regional wage adjustors based on the Health Service | 18 | | Areas (HSA) groupings and adjusters in effect on April 30, | 19 | | 2012 shall be included. | 20 | | (4) Case mix index shall be assigned to each resident | 21 | | class based on the Centers for Medicare and Medicaid | 22 | | Services staff time measurement study in effect on July 1, | 23 | | 2013, utilizing an index maximization approach. | 24 | | (5) The pool of funds available for distribution by | 25 | | case mix and the base facility rate shall be determined | 26 | | using the formula contained in subsection (d-1). |
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| 1 | | (d-1) Calculation of base year Statewide RUG-IV nursing | 2 | | base per diem rate. | 3 | | (1) Base rate spending pool shall be: | 4 | | (A) The base year resident days which are | 5 | | calculated by multiplying the number of Medicaid | 6 | | residents in each nursing home as indicated in the MDS | 7 | | data defined in paragraph (4) by 365. | 8 | | (B) Each facility's nursing component per diem in | 9 | | effect on July 1, 2012 shall be multiplied by | 10 | | subsection (A). | 11 | | (C) Thirteen million is added to the product of | 12 | | subparagraph (A) and subparagraph (B) to adjust for the | 13 | | exclusion of nursing homes defined in paragraph (5). | 14 | | (2) For each nursing home with Medicaid residents as | 15 | | indicated by the MDS data defined in paragraph (4), | 16 | | weighted days adjusted for case mix and regional wage | 17 | | adjustment shall be calculated. For each home this | 18 | | calculation is the product of: | 19 | | (A) Base year resident days as calculated in | 20 | | subparagraph (A) of paragraph (1). | 21 | | (B) The nursing home's regional wage adjustor | 22 | | based on the Health Service Areas (HSA) groupings and | 23 | | adjustors in effect on April 30, 2012. | 24 | | (C) Facility weighted case mix which is the number | 25 | | of Medicaid residents as indicated by the MDS data | 26 | | defined in paragraph (4) multiplied by the associated |
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| 1 | | case weight for the RUG-IV 48 grouper model using | 2 | | standard RUG-IV procedures for index maximization. | 3 | | (D) The sum of the products calculated for each | 4 | | nursing home in subparagraphs (A) through (C) above | 5 | | shall be the base year case mix, rate adjusted weighted | 6 | | days. | 7 | | (3) The Statewide RUG-IV nursing base per diem rate: | 8 | | (A) on January 1, 2014 shall be the quotient of the | 9 | | paragraph (1) divided by the sum calculated under | 10 | | subparagraph (D) of paragraph (2); and | 11 | | (B) on and after July 1, 2014, shall be the amount | 12 | | calculated under subparagraph (A) of this paragraph | 13 | | (3) plus $1.76. | 14 | | (4) Minimum Data Set (MDS) comprehensive assessments | 15 | | for Medicaid residents on the last day of the quarter used | 16 | | to establish the base rate. | 17 | | (5) Nursing facilities designated as of July 1, 2012 by | 18 | | the Department as "Institutions for Mental Disease" shall | 19 | | be excluded from all calculations under this subsection. | 20 | | The data from these facilities shall not be used in the | 21 | | computations described in paragraphs (1) through (4) above | 22 | | to establish the base rate. | 23 | | (e) Beginning July 1, 2014, the Department shall allocate | 24 | | funding in the amount up to $10,000,000 for per diem add-ons to | 25 | | the RUGS methodology for dates of service on and after July 1, | 26 | | 2014: |
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| 1 | | (1) $0.63 for each resident who scores in I4200 | 2 | | Alzheimer's Disease or I4800 non-Alzheimer's Dementia. | 3 | | (2) $2.67 for each resident who scores either a "1" or | 4 | | "2" in any items S1200A through S1200I and also scores in | 5 | | RUG groups PA1, PA2, BA1, or BA2. | 6 | | (e-1) (Blank). | 7 | | (e-2) For dates of services beginning January 1, 2014, the | 8 | | RUG-IV nursing component per diem for a nursing home shall be | 9 | | the product of the statewide RUG-IV nursing base per diem rate, | 10 | | the facility average case mix index, and the regional wage | 11 | | adjustor. Transition rates for services provided between | 12 | | January 1, 2014 and December 31, 2014 shall be as follows: | 13 | | (1) The transition RUG-IV per diem nursing rate for | 14 | | nursing homes whose rate calculated in this subsection | 15 | | (e-2) is greater than the nursing component rate in effect | 16 | | July 1, 2012 shall be paid the sum of: | 17 | | (A) The nursing component rate in effect July 1, | 18 | | 2012; plus | 19 | | (B) The difference of the RUG-IV nursing component | 20 | | per diem calculated for the current quarter minus the | 21 | | nursing component rate in effect July 1, 2012 | 22 | | multiplied by 0.88. | 23 | | (2) The transition RUG-IV per diem nursing rate for | 24 | | nursing homes whose rate calculated in this subsection | 25 | | (e-2) is less than the nursing component rate in effect | 26 | | July 1, 2012 shall be paid the sum of: |
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| 1 | | (A) The nursing component rate in effect July 1, | 2 | | 2012; plus | 3 | | (B) The difference of the RUG-IV nursing component | 4 | | per diem calculated for the current quarter minus the | 5 | | nursing component rate in effect July 1, 2012 | 6 | | multiplied by 0.13. | 7 | | (f) Notwithstanding any other provision of this Code, on | 8 | | and after July 1, 2012, reimbursement rates associated with the | 9 | | nursing or support components of the current nursing facility | 10 | | rate methodology shall not increase beyond the level effective | 11 | | May 1, 2011 until a new reimbursement system based on the RUGs | 12 | | IV 48 grouper model has been fully operationalized. | 13 | | (g) Notwithstanding any other provision of this Code, on | 14 | | and after July 1, 2012, for facilities not designated by the | 15 | | Department of Healthcare and Family Services as "Institutions | 16 | | for Mental Disease", rates effective May 1, 2011 shall be | 17 | | adjusted as follows: | 18 | | (1) Individual nursing rates for residents classified | 19 | | in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter | 20 | | ending March 31, 2012 shall be reduced by 10%; | 21 | | (2) Individual nursing rates for residents classified | 22 | | in all other RUG IV groups shall be reduced by 1.0%; | 23 | | (3) Facility rates for the capital and support | 24 | | components shall be reduced by 1.7%. | 25 | | (h) Notwithstanding any other provision of this Code, on | 26 | | and after July 1, 2012, nursing facilities designated by the |
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| 1 | | Department of Healthcare and Family Services as "Institutions | 2 | | for Mental Disease" and "Institutions for Mental Disease" that | 3 | | are facilities licensed under the Specialized Mental Health | 4 | | Rehabilitation Act of 2013 shall have the nursing, | 5 | | socio-developmental, capital, and support components of their | 6 | | reimbursement rate effective May 1, 2011 reduced in total by | 7 | | 2.7%. | 8 | | (i) On and after July 1, 2014, the reimbursement rates for | 9 | | the support component of the nursing facility rate for | 10 | | facilities licensed under the Nursing Home Care Act as skilled | 11 | | or intermediate care facilities shall be the rate in effect on | 12 | | June 30, 2014 increased by 8.17%. | 13 | | (Source: P.A. 98-104, Article 6, Section 6-240, eff. 7-22-13; | 14 | | 98-104, Article 11, Section 11-35, eff. 7-22-13; 98-651, eff. | 15 | | 6-16-14; 98-727, eff. 7-16-14; 98-756, eff. 7-16-14; 99-78, | 16 | | eff. 7-20-15.)
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