Full Text of HB5561 97th General Assembly
HB5561 97TH GENERAL ASSEMBLY |
| | 97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012 HB5561 Introduced 2/15/2012, by Rep. Greg Harris SYNOPSIS AS INTRODUCED: |
| 305 ILCS 5/5-5.4 | from Ch. 23, par. 5-5.4 |
| Amends the Illinois Public Aid Code. Makes a technical change in a Section concerning standards of payment of skilled
nursing and intermediate care services.
|
| |
| | A BILL FOR |
|
| | | HB5561 | | LRB097 14500 KTG 59355 b |
|
| 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 5-5.4 as follows: | 6 | | (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4) | 7 | | Sec. 5-5.4. Standards of Payment - Department of Healthcare | 8 | | and Family Services.
The The Department of Healthcare and | 9 | | Family Services shall develop standards of payment of
nursing | 10 | | facility and ICF/DD services in facilities providing such | 11 | | services
under this Article which:
| 12 | | (1) Provide for the determination of a facility's payment
| 13 | | for nursing facility or ICF/DD services on a prospective basis.
| 14 | | The amount of the payment rate for all nursing facilities | 15 | | certified by the
Department of Public Health under the ID/DD | 16 | | Community Care Act or the Nursing Home Care Act as Intermediate
| 17 | | Care for the Developmentally Disabled facilities, Long Term | 18 | | Care for Under Age
22 facilities, Skilled Nursing facilities, | 19 | | or Intermediate Care facilities
under the
medical assistance | 20 | | program shall be prospectively established annually on the
| 21 | | basis of historical, financial, and statistical data | 22 | | reflecting actual costs
from prior years, which shall be | 23 | | applied to the current rate year and updated
for inflation, |
| | | HB5561 | - 2 - | LRB097 14500 KTG 59355 b |
|
| 1 | | except that the capital cost element for newly constructed
| 2 | | facilities shall be based upon projected budgets. The annually | 3 | | established
payment rate shall take effect on July 1 in 1984 | 4 | | and subsequent years. No rate
increase and no
update for | 5 | | inflation shall be provided on or after July 1, 1994 and before
| 6 | | July 1, 2012, unless specifically provided for in this
Section.
| 7 | | The changes made by Public Act 93-841
extending the duration of | 8 | | the prohibition against a rate increase or update for inflation | 9 | | are effective retroactive to July 1, 2004.
| 10 | | For facilities licensed by the Department of Public Health | 11 | | under the Nursing
Home Care Act as Intermediate Care for the | 12 | | Developmentally Disabled facilities
or Long Term Care for Under | 13 | | Age 22 facilities, the rates taking effect on July
1, 1998 | 14 | | shall include an increase of 3%. For facilities licensed by the
| 15 | | Department of Public Health under the Nursing Home Care Act as | 16 | | Skilled Nursing
facilities or Intermediate Care facilities, | 17 | | the rates taking effect on July 1,
1998 shall include an | 18 | | increase of 3% plus $1.10 per resident-day, as defined by
the | 19 | | Department. For facilities licensed by the Department of Public | 20 | | Health under the Nursing Home Care Act as Intermediate Care | 21 | | Facilities for the Developmentally Disabled or Long Term Care | 22 | | for Under Age 22 facilities, the rates taking effect on January | 23 | | 1, 2006 shall include an increase of 3%.
For facilities | 24 | | licensed by the Department of Public Health under the Nursing | 25 | | Home Care Act as Intermediate Care Facilities for the | 26 | | Developmentally Disabled or Long Term Care for Under Age 22 |
| | | HB5561 | - 3 - | LRB097 14500 KTG 59355 b |
|
| 1 | | facilities, the rates taking effect on January 1, 2009 shall | 2 | | include an increase sufficient to provide a $0.50 per hour wage | 3 | | increase for non-executive staff. | 4 | | For facilities licensed by the Department of Public Health | 5 | | under the
Nursing Home Care Act as Intermediate Care for the | 6 | | Developmentally Disabled
facilities or Long Term Care for Under | 7 | | Age 22 facilities, the rates taking
effect on July 1, 1999 | 8 | | shall include an increase of 1.6% plus $3.00 per
resident-day, | 9 | | as defined by the Department. For facilities licensed by the
| 10 | | Department of Public Health under the Nursing Home Care Act as | 11 | | Skilled Nursing
facilities or Intermediate Care facilities, | 12 | | the rates taking effect on July 1,
1999 shall include an | 13 | | increase of 1.6% and, for services provided on or after
October | 14 | | 1, 1999, shall be increased by $4.00 per resident-day, as | 15 | | defined by
the Department.
| 16 | | 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, 2000 | 20 | | shall include an increase of 2.5% per resident-day,
as defined | 21 | | by the Department. For facilities licensed by the Department of
| 22 | | Public Health under the Nursing Home Care Act as Skilled | 23 | | Nursing facilities or
Intermediate Care facilities, the rates | 24 | | taking effect on July 1, 2000 shall
include an increase of 2.5% | 25 | | per resident-day, as defined by the Department.
| 26 | | For facilities licensed by the Department of Public Health |
| | | HB5561 | - 4 - | LRB097 14500 KTG 59355 b |
|
| 1 | | under the
Nursing Home Care Act as skilled nursing facilities | 2 | | or intermediate care
facilities, a new payment methodology must | 3 | | be implemented for the nursing
component of the rate effective | 4 | | July 1, 2003. The Department of Public Aid
(now Healthcare and | 5 | | Family Services) shall develop the new payment methodology | 6 | | using the Minimum Data Set
(MDS) as the instrument to collect | 7 | | information concerning nursing home
resident condition | 8 | | necessary to compute the rate. The Department
shall develop the | 9 | | new payment methodology to meet the unique needs of
Illinois | 10 | | nursing home residents while remaining subject to the | 11 | | appropriations
provided by the General Assembly.
A transition | 12 | | period from the payment methodology in effect on June 30, 2003
| 13 | | to the payment methodology in effect on July 1, 2003 shall be | 14 | | provided for a
period not exceeding 3 years and 184 days after | 15 | | implementation of the new payment
methodology as follows:
| 16 | | (A) For a facility that would receive a lower
nursing | 17 | | component rate per patient day under the new system than | 18 | | the facility
received
effective on the date immediately | 19 | | preceding the date that the Department
implements the new | 20 | | payment methodology, the nursing component rate per | 21 | | patient
day for the facility
shall be held at
the level in | 22 | | effect on the date immediately preceding the date that the
| 23 | | Department implements the new payment methodology until a | 24 | | higher nursing
component rate of
reimbursement is achieved | 25 | | by that
facility.
| 26 | | (B) For a facility that would receive a higher nursing |
| | | HB5561 | - 5 - | LRB097 14500 KTG 59355 b |
|
| 1 | | component rate per
patient day under the payment | 2 | | methodology in effect on July 1, 2003 than the
facility | 3 | | received effective on the date immediately preceding the | 4 | | date that the
Department implements the new payment | 5 | | methodology, the nursing component rate
per patient day for | 6 | | the facility shall be adjusted.
| 7 | | (C) Notwithstanding paragraphs (A) and (B), the | 8 | | nursing component rate per
patient day for the facility | 9 | | shall be adjusted subject to appropriations
provided by the | 10 | | General Assembly.
| 11 | | For facilities licensed by the Department of Public Health | 12 | | under the
Nursing Home Care Act as Intermediate Care for the | 13 | | Developmentally Disabled
facilities or Long Term Care for Under | 14 | | Age 22 facilities, the rates taking
effect on March 1, 2001 | 15 | | shall include a statewide increase of 7.85%, as
defined by the | 16 | | Department.
| 17 | | 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, except facilities participating | 21 | | in the Department's demonstration program pursuant to the | 22 | | provisions of Title 77, Part 300, Subpart T of the Illinois | 23 | | Administrative Code, the numerator of the ratio used by the | 24 | | Department of Healthcare and Family Services to compute the | 25 | | rate payable under this Section using the Minimum Data Set | 26 | | (MDS) methodology shall incorporate the following annual |
| | | HB5561 | - 6 - | LRB097 14500 KTG 59355 b |
|
| 1 | | amounts as the additional funds appropriated to the Department | 2 | | specifically to pay for rates based on the MDS nursing | 3 | | component methodology in excess of the funding in effect on | 4 | | December 31, 2006: | 5 | | (i) For rates taking effect January 1, 2007, | 6 | | $60,000,000. | 7 | | (ii) For rates taking effect January 1, 2008, | 8 | | $110,000,000. | 9 | | (iii) For rates taking effect January 1, 2009, | 10 | | $194,000,000. | 11 | | (iv) For rates taking effect April 1, 2011, or the | 12 | | first day of the month that begins at least 45 days after | 13 | | the effective date of this amendatory Act of the 96th | 14 | | General Assembly, $416,500,000 or an amount as may be | 15 | | necessary to complete the transition to the MDS methodology | 16 | | for the nursing component of the rate. Increased payments | 17 | | under this item (iv) are not due and payable, however, | 18 | | until (i) the methodologies described in this paragraph are | 19 | | approved by the federal government in an appropriate State | 20 | | Plan amendment and (ii) the assessment imposed by Section | 21 | | 5B-2 of this Code is determined to be a permissible tax | 22 | | under Title XIX of the Social Security Act. | 23 | | Notwithstanding any other provision of this Section, for | 24 | | facilities licensed by the Department of Public Health under | 25 | | the Nursing Home Care Act as skilled nursing facilities or | 26 | | intermediate care facilities, the support component of the |
| | | HB5561 | - 7 - | LRB097 14500 KTG 59355 b |
|
| 1 | | rates taking effect on January 1, 2008 shall be computed using | 2 | | the most recent cost reports on file with the Department of | 3 | | Healthcare and Family Services no later than April 1, 2005, | 4 | | updated for inflation to January 1, 2006. | 5 | | For facilities licensed by the Department of Public Health | 6 | | under the
Nursing Home Care Act as Intermediate Care for the | 7 | | Developmentally Disabled
facilities or Long Term Care for Under | 8 | | Age 22 facilities, the rates taking
effect on April 1, 2002 | 9 | | shall include a statewide increase of 2.0%, as
defined by the | 10 | | Department.
This increase terminates on July 1, 2002;
beginning | 11 | | July 1, 2002 these rates are reduced to the level of the rates
| 12 | | in effect on March 31, 2002, as defined by the Department.
| 13 | | For facilities licensed by the Department of Public Health | 14 | | under the
Nursing Home Care Act as skilled nursing facilities | 15 | | or intermediate care
facilities, the rates taking effect on | 16 | | July 1, 2001 shall be computed using the most recent cost | 17 | | reports
on file with the Department of Public Aid no later than | 18 | | April 1, 2000,
updated for inflation to January 1, 2001. For | 19 | | rates effective July 1, 2001
only, rates shall be the greater | 20 | | of the rate computed for July 1, 2001
or the rate effective on | 21 | | June 30, 2001.
| 22 | | Notwithstanding any other provision of this Section, for | 23 | | facilities
licensed by the Department of Public Health under | 24 | | the Nursing Home Care Act
as skilled nursing facilities or | 25 | | intermediate care facilities, the Illinois
Department shall | 26 | | determine by rule the rates taking effect on July 1, 2002,
|
| | | HB5561 | - 8 - | LRB097 14500 KTG 59355 b |
|
| 1 | | which shall be 5.9% less than the rates in effect on June 30, | 2 | | 2002.
| 3 | | Notwithstanding any other provision of this Section, for | 4 | | facilities
licensed by the Department of Public Health under | 5 | | the Nursing Home Care Act as
skilled nursing
facilities or | 6 | | intermediate care facilities, if the payment methodologies | 7 | | required under Section 5A-12 and the waiver granted under 42 | 8 | | CFR 433.68 are approved by the United States Centers for | 9 | | Medicare and Medicaid Services, the rates taking effect on July | 10 | | 1, 2004 shall be 3.0% greater than the rates in effect on June | 11 | | 30, 2004. These rates shall take
effect only upon approval and
| 12 | | implementation of the payment methodologies required under | 13 | | Section 5A-12.
| 14 | | Notwithstanding any other provisions of this Section, for | 15 | | facilities licensed by the Department of Public Health under | 16 | | the Nursing Home Care Act as skilled nursing facilities or | 17 | | intermediate care facilities, the rates taking effect on | 18 | | January 1, 2005 shall be 3% more than the rates in effect on | 19 | | December 31, 2004.
| 20 | | 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, 2009, the | 24 | | per diem support component of the rates effective on January 1, | 25 | | 2008, computed using the most recent cost reports on file with | 26 | | the Department of Healthcare and Family Services no later than |
| | | HB5561 | - 9 - | LRB097 14500 KTG 59355 b |
|
| 1 | | April 1, 2005, updated for inflation to January 1, 2006, shall | 2 | | be increased to the amount that would have been derived using | 3 | | standard Department of Healthcare and Family Services methods, | 4 | | procedures, and inflators. | 5 | | Notwithstanding any other provisions of this Section, for | 6 | | facilities licensed by the Department of Public Health under | 7 | | the Nursing Home Care Act as intermediate care facilities that | 8 | | are federally defined as Institutions for Mental Disease, or | 9 | | facilities licensed by the Department of Public Health under | 10 | | the Specialized Mental Health Rehabilitation Facilities Act, a | 11 | | socio-development component rate equal to 6.6% of the | 12 | | facility's nursing component rate as of January 1, 2006 shall | 13 | | be established and paid effective July 1, 2006. The | 14 | | socio-development component of the rate shall be increased by a | 15 | | factor of 2.53 on the first day of the month that begins at | 16 | | least 45 days after January 11, 2008 (the effective date of | 17 | | Public Act 95-707). As of August 1, 2008, the socio-development | 18 | | component rate shall be equal to 6.6% of the facility's nursing | 19 | | component rate as of January 1, 2006, multiplied by a factor of | 20 | | 3.53. For services provided on or after April 1, 2011, or the | 21 | | first day of the month that begins at least 45 days after the | 22 | | effective date of this amendatory Act of the 96th General | 23 | | Assembly, whichever is later, the Illinois Department may by | 24 | | rule adjust these socio-development component rates, and may | 25 | | use different adjustment methodologies for those facilities | 26 | | participating, and those not participating, in the Illinois |
| | | HB5561 | - 10 - | LRB097 14500 KTG 59355 b |
|
| 1 | | Department's demonstration program pursuant to the provisions | 2 | | of Title 77, Part 300, Subpart T of the Illinois Administrative | 3 | | Code, but in no case may such rates be diminished below those | 4 | | in effect on August 1, 2008.
| 5 | | For facilities
licensed
by the
Department of Public Health | 6 | | under the Nursing Home Care Act as Intermediate
Care for
the | 7 | | Developmentally Disabled facilities or as long-term care | 8 | | facilities for
residents under 22 years of age, the rates | 9 | | taking effect on July 1,
2003 shall
include a statewide | 10 | | increase of 4%, as defined by the Department.
| 11 | | For facilities licensed by the Department of Public Health | 12 | | under the
Nursing Home Care Act as Intermediate Care for the | 13 | | Developmentally Disabled
facilities or Long Term Care for Under | 14 | | Age 22 facilities, the rates taking
effect on the first day of | 15 | | the month that begins at least 45 days after the effective date | 16 | | of this amendatory Act of the 95th General Assembly shall | 17 | | include a statewide increase of 2.5%, as
defined by the | 18 | | Department. | 19 | | Notwithstanding any other provision of this Section, for | 20 | | facilities licensed by the Department of Public Health under | 21 | | the Nursing Home Care Act as skilled nursing facilities or | 22 | | intermediate care facilities, effective January 1, 2005, | 23 | | facility rates shall be increased by the difference between (i) | 24 | | a facility's per diem property, liability, and malpractice | 25 | | insurance costs as reported in the cost report filed with the | 26 | | Department of Public Aid and used to establish rates effective |
| | | HB5561 | - 11 - | LRB097 14500 KTG 59355 b |
|
| 1 | | July 1, 2001 and (ii) those same costs as reported in the | 2 | | facility's 2002 cost report. These costs shall be passed | 3 | | through to the facility without caps or limitations, except for | 4 | | adjustments required under normal auditing procedures.
| 5 | | Rates established effective each July 1 shall govern | 6 | | payment
for services rendered throughout that fiscal year, | 7 | | except that rates
established on July 1, 1996 shall be | 8 | | increased by 6.8% for services
provided on or after January 1, | 9 | | 1997. Such rates will be based
upon the rates calculated for | 10 | | the year beginning July 1, 1990, and for
subsequent years | 11 | | thereafter until June 30, 2001 shall be based on the
facility | 12 | | cost reports
for the facility fiscal year ending at any point | 13 | | in time during the previous
calendar year, updated to the | 14 | | midpoint of the rate year. The cost report
shall be on file | 15 | | with the Department no later than April 1 of the current
rate | 16 | | year. Should the cost report not be on file by April 1, the | 17 | | Department
shall base the rate on the latest cost report filed | 18 | | by each skilled care
facility and intermediate care facility, | 19 | | updated to the midpoint of the
current rate year. In | 20 | | determining rates for services rendered on and after
July 1, | 21 | | 1985, fixed time shall not be computed at less than zero. The
| 22 | | Department shall not make any alterations of regulations which | 23 | | would reduce
any component of the Medicaid rate to a level | 24 | | below what that component would
have been utilizing in the rate | 25 | | effective on July 1, 1984.
| 26 | | (2) Shall take into account the actual costs incurred by |
| | | HB5561 | - 12 - | LRB097 14500 KTG 59355 b |
|
| 1 | | facilities
in providing services for recipients of skilled | 2 | | nursing and intermediate
care services under the medical | 3 | | assistance program.
| 4 | | (3) Shall take into account the medical and psycho-social
| 5 | | characteristics and needs of the patients.
| 6 | | (4) Shall take into account the actual costs incurred by | 7 | | facilities in
meeting licensing and certification standards | 8 | | imposed and prescribed by the
State of Illinois, any of its | 9 | | political subdivisions or municipalities and by
the U.S. | 10 | | Department of Health and Human Services pursuant to Title XIX | 11 | | of the
Social Security Act.
| 12 | | The Department of Healthcare and Family Services
shall | 13 | | develop precise standards for
payments to reimburse nursing | 14 | | facilities for any utilization of
appropriate rehabilitative | 15 | | personnel for the provision of rehabilitative
services which is | 16 | | authorized by federal regulations, including
reimbursement for | 17 | | services provided by qualified therapists or qualified
| 18 | | assistants, and which is in accordance with accepted | 19 | | professional
practices. Reimbursement also may be made for | 20 | | utilization of other
supportive personnel under appropriate | 21 | | supervision.
| 22 | | The Department shall develop enhanced payments to offset | 23 | | the additional costs incurred by a
facility serving exceptional | 24 | | need residents and shall allocate at least $8,000,000 of the | 25 | | funds
collected from the assessment established by Section 5B-2 | 26 | | of this Code for such payments. For
the purpose of this |
| | | HB5561 | - 13 - | LRB097 14500 KTG 59355 b |
|
| 1 | | Section, "exceptional needs" means, but need not be limited to, | 2 | | ventilator care, tracheotomy care,
bariatric care, complex | 3 | | wound care, and traumatic brain injury care. The enhanced | 4 | | payments for exceptional need residents under this paragraph | 5 | | are not due and payable, however, until (i) the methodologies | 6 | | described in this paragraph are approved by the federal | 7 | | government in an appropriate State Plan amendment and (ii) the | 8 | | assessment imposed by Section 5B-2 of this Code is determined | 9 | | to be a permissible tax under Title XIX of the Social Security | 10 | | Act. | 11 | | (5) Beginning July 1, 2012 the methodologies for | 12 | | reimbursement of nursing facility services as provided under | 13 | | this Section 5-5.4 shall no longer be applicable for bills | 14 | | payable for State fiscal years 2012 and thereafter. | 15 | | (6) No payment increase under this Section for the MDS | 16 | | methodology, exceptional care residents, or the | 17 | | socio-development component rate established by Public Act | 18 | | 96-1530 of the 96th General Assembly and funded by the | 19 | | assessment imposed under Section 5B-2 of this Code shall be due | 20 | | and payable until after the Department notifies the long-term | 21 | | care providers, in writing, that the payment methodologies to | 22 | | long-term care providers required under this Section have been | 23 | | approved by the Centers for Medicare and Medicaid Services of | 24 | | the U.S. Department of Health and Human Services and the | 25 | | waivers under 42 CFR 433.68 for the assessment imposed by this | 26 | | Section, if necessary, have been granted by the Centers for |
| | | HB5561 | - 14 - | LRB097 14500 KTG 59355 b |
|
| 1 | | Medicare and Medicaid Services of the U.S. Department of Health | 2 | | and Human Services. Upon notification to the Department of | 3 | | approval of the payment methodologies required under this | 4 | | Section and the waivers granted under 42 CFR 433.68, all | 5 | | increased payments otherwise due under this Section prior to | 6 | | the date of notification shall be due and payable within 90 | 7 | | days of the date federal approval is received. | 8 | | (Source: P.A. 96-45, eff. 7-15-09; 96-339, eff. 7-1-10; 96-959, | 9 | | eff. 7-1-10; 96-1000, eff. 7-2-10; 96-1530, eff. 2-16-11; | 10 | | 97-10, eff. 6-14-11; 97-38, eff. 6-28-11; 97-227, eff. 1-1-12; | 11 | | 97-584, eff. 8-26-11; revised 10-4-11.)
|
|