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Public Act 096-1123 Public Act 1123 96TH GENERAL ASSEMBLY |
Public Act 096-1123 | SB3290 Enrolled | LRB096 20040 KTG 35543 b |
|
| AN ACT concerning public aid.
| Be it enacted by the People of the State of Illinois,
| represented in the General Assembly:
| Section 5. The Alternative Health Care Delivery Act is | amended by changing Section 30 as follows:
| (210 ILCS 3/30)
| Sec. 30. Demonstration program requirements. The | requirements set forth in
this Section shall apply to | demonstration programs.
| (a) There shall be no more than:
| (i) 3 subacute care hospital alternative health care | models in the City of
Chicago (one of which shall be | located on a designated site and shall have been
licensed | as a hospital under the Illinois Hospital Licensing Act | within the 10
years immediately before the application for | a license);
| (ii) 2 subacute care hospital alternative health care | models in the
demonstration program for each of the | following areas:
| (1) Cook County outside the City of Chicago.
| (2) DuPage, Kane, Lake, McHenry, and Will | Counties.
| (3) Municipalities with a population greater than |
| 50,000 not
located in the areas described in item (i) | of subsection (a) and paragraphs
(1) and (2) of item | (ii) of subsection (a); and
| (iii) 4 subacute care hospital alternative health care
| models in the demonstration program for rural areas.
| In selecting among applicants for these
licenses in rural | areas, the Health Facilities and Services Review Board and the
| Department shall give preference to hospitals that may be | unable for economic
reasons to provide continued service to the | community in which they are located
unless the hospital were to | receive an alternative health care model license.
| (a-5) There shall be no more than the total number of | postsurgical
recovery care centers with a certificate of need | for beds as of January 1, 2008.
| (a-10) There shall be no more than a total of 9 children's | respite care
center alternative health care models in the | demonstration program, which shall
be located as follows:
| (1) Two in the City of Chicago.
| (2) One in Cook County outside the City of Chicago.
| (3) A total of 2 in the area comprised of DuPage, Kane, | Lake, McHenry, and
Will counties.
| (4) A total of 2 in municipalities with a population of | 50,000 or more and
not
located in the areas described in | paragraphs (1), (2), or (3).
| (5) A total of 2 in rural areas, as defined by the | Health Facilities
and Services Review Board.
|
| No more than one children's respite care model owned and | operated by a
licensed skilled pediatric facility shall be | located in each of the areas
designated in this subsection | (a-10).
| (a-15) There shall be 2 authorized community-based | residential
rehabilitation center alternative health care | models in the demonstration
program.
| (a-20) There shall be an authorized
Alzheimer's disease | management center alternative health care model in the
| demonstration program. The Alzheimer's disease management | center shall be
located in Will
County, owned by a
| not-for-profit entity, and endorsed by a resolution approved by | the county
board before the effective date of this amendatory | Act of the 91st General
Assembly.
| (a-25) There shall be no more than 10 birth center | alternative health care
models in the demonstration program, | located as follows:
| (1) Four in the area comprising Cook, DuPage, Kane, | Lake, McHenry, and
Will counties, one of
which shall be | owned or operated by a hospital and one of which shall be | owned
or operated by a federally qualified health center.
| (2) Three in municipalities with a population of 50,000 | or more not
located in the area described in paragraph (1) | of this subsection, one of
which shall be owned or operated | by a hospital and one of which shall be owned
or operated | by a federally qualified health center.
|
| (3) Three in rural areas, one of which shall be owned | or operated by a
hospital and one of which shall be owned | or operated by a federally qualified
health center.
| The first 3 birth centers authorized to operate by the | Department shall be
located in or predominantly serve the | residents of a health professional
shortage area as determined | by the United States Department of Health and Human
Services. | There shall be no more than 2 birth centers authorized to | operate in
any single health planning area for obstetric | services as determined under the
Illinois Health Facilities | Planning Act. If a birth center is located outside
of a
health | professional shortage area, (i) the birth center shall be | located in a
health planning
area with a demonstrated need for | obstetrical service beds, as determined by
the Health | Facilities and Services Review Board or (ii) there must be a
| reduction in
the existing number of obstetrical service beds in | the planning area so that
the establishment of the birth center | does not result in an increase in the
total number of | obstetrical service beds in the health planning area.
| (b) Alternative health care models, other than a model | authorized under subsection (a-10) or subsections (a-10) and
| (a-20), shall obtain a certificate of
need from the Health | Facilities and Services Review Board under the Illinois
Health | Facilities Planning Act before receiving a license by the
| Department.
If, after obtaining its initial certificate of | need, an alternative health
care delivery model that is a |
| community based residential rehabilitation center
seeks to
| increase the bed capacity of that center, it must obtain a | certificate of need
from the Health Facilities and Services | Review Board before increasing the bed
capacity. Alternative
| health care models in medically underserved areas
shall receive | priority in obtaining a certificate of need.
| (c) An alternative health care model license shall be | issued for a
period of one year and shall be annually renewed | if the facility or
program is in substantial compliance with | the Department's rules
adopted under this Act. A licensed | alternative health care model that continues
to be in | substantial compliance after the conclusion of the | demonstration
program shall be eligible for annual renewals | unless and until a different
licensure program for that type of | health care model is established by
legislation, except that a | postsurgical recovery care center meeting the following | requirements may apply within 3 years after August 25, 2009 | ( the effective date of Public Act 96-669) this amendatory Act | of the 96th General Assembly for a Certificate of Need permit | to operate as a hospital: | (1) The postsurgical recovery care center shall apply | to the Illinois Health Facilities Planning Board for a | Certificate of Need permit to discontinue the postsurgical | recovery care center and to establish a hospital. | (2) If the postsurgical recovery care center obtains a | Certificate of Need permit to operate as a hospital, it |
| shall apply for licensure as a hospital under the Hospital | Licensing Act and shall meet all statutory and regulatory | requirements of a hospital. | (3) After obtaining licensure as a hospital, any | license as an ambulatory surgical treatment center and any | license as a post-surgical recovery care center shall be | null and void. | (4) The former postsurgical recovery care center that | receives a hospital license must seek and use its best | efforts to maintain certification under Titles XVIII and | XIX of the federal Social Security Act. | The Department may issue a provisional license to any
| alternative health care model that does not substantially | comply with the
provisions of this Act and the rules adopted | under this Act if (i)
the Department finds that the alternative | health care model has undertaken
changes and corrections which | upon completion will render the alternative
health care model | in substantial compliance with this Act and rules and
(ii) the | health and safety of the patients of the alternative
health | care model will be protected during the period for which the | provisional
license is issued. The Department shall advise the | licensee of
the conditions under which the provisional license | is issued, including
the manner in which the alternative health | care model fails to comply with
the provisions of this Act and | rules, and the time within which the changes
and corrections | necessary for the alternative health care model to
|
| substantially comply with this Act and rules shall be | completed.
| (d) Alternative health care models shall seek | certification under Titles
XVIII and XIX of the federal Social | Security Act. In addition, alternative
health care models shall | provide charitable care consistent with that provided
by | comparable health care providers in the geographic area.
| (d-5) (Blank) The Department of Healthcare and Family | Services (formerly Illinois Department of Public Aid), in | cooperation with the
Illinois Department of
Public Health, | shall develop and implement a reimbursement methodology for all
| facilities participating in the demonstration program. The | Department of Healthcare and Family Services shall keep a | record of services provided under the demonstration
program to | recipients of medical assistance under the Illinois Public Aid | Code
and shall submit an annual report of that information to | the Illinois
Department of Public Health .
| (e) Alternative health care models shall, to the extent | possible,
link and integrate their services with nearby health | care facilities.
| (f) Each alternative health care model shall implement a | quality
assurance program with measurable benefits and at | reasonable cost.
| (Source: P.A. 95-331, eff. 8-21-07; 95-445, eff. 1-1-08; 96-31, | eff. 6-30-09; 96-129, eff. 8-4-09; 96-669, eff. 8-25-09; | 96-812, eff. 1-1-10; revised 11-4-09.)
|
| Section 10. The Illinois Public Aid Code is amended by | changing Sections 5-2 and 5-5.5 and by adding Section 12-8.2 as | follows:
| (305 ILCS 5/5-2) (from Ch. 23, par. 5-2)
| Sec. 5-2. Classes of Persons Eligible. Medical assistance | under this
Article shall be available to any of the following | classes of persons in
respect to whom a plan for coverage has | been submitted to the Governor
by the Illinois Department and | approved by him:
| 1. Recipients of basic maintenance grants under | Articles III and IV.
| 2. Persons otherwise eligible for basic maintenance | under Articles
III and IV, excluding any eligibility | requirements that are inconsistent with any federal law or | federal regulation, as interpreted by the U.S. Department | of Health and Human Services, but who fail to qualify | thereunder on the basis of need or who qualify but are not | receiving basic maintenance under Article IV, and
who have | insufficient income and resources to meet the costs of
| necessary medical care, including but not limited to the | following:
| (a) All persons otherwise eligible for basic | maintenance under Article
III but who fail to qualify | under that Article on the basis of need and who
meet |
| either of the following requirements:
| (i) their income, as determined by the | Illinois Department in
accordance with any federal | requirements, is equal to or less than 70% in
| fiscal year 2001, equal to or less than 85% in | fiscal year 2002 and until
a date to be determined | by the Department by rule, and equal to or less
| than 100% beginning on the date determined by the | Department by rule, of the nonfarm income official | poverty
line, as defined by the federal Office of | Management and Budget and revised
annually in | accordance with Section 673(2) of the Omnibus | Budget Reconciliation
Act of 1981, applicable to | families of the same size; or
| (ii) their income, after the deduction of | costs incurred for medical
care and for other types | of remedial care, is equal to or less than 70% in
| fiscal year 2001, equal to or less than 85% in | fiscal year 2002 and until
a date to be determined | by the Department by rule, and equal to or less
| than 100% beginning on the date determined by the | Department by rule, of the nonfarm income official | poverty
line, as defined in item (i) of this | subparagraph (a).
| (b) All persons who, excluding any eligibility | requirements that are inconsistent with any federal |
| law or federal regulation, as interpreted by the U.S. | Department of Health and Human Services, would be | determined eligible for such basic
maintenance under | Article IV by disregarding the maximum earned income
| permitted by federal law.
| 3. Persons who would otherwise qualify for Aid to the | Medically
Indigent under Article VII.
| 4. Persons not eligible under any of the preceding | paragraphs who fall
sick, are injured, or die, not having | sufficient money, property or other
resources to meet the | costs of necessary medical care or funeral and burial
| expenses.
| 5.(a) Women during pregnancy, after the fact
of | pregnancy has been determined by medical diagnosis, and | during the
60-day period beginning on the last day of the | pregnancy, together with
their infants and children born | after September 30, 1983,
whose income and
resources are | insufficient to meet the costs of necessary medical care to
| the maximum extent possible under Title XIX of the
Federal | Social Security Act.
| (b) The Illinois Department and the Governor shall | provide a plan for
coverage of the persons eligible under | paragraph 5(a) by April 1, 1990. Such
plan shall provide | ambulatory prenatal care to pregnant women during a
| presumptive eligibility period and establish an income | eligibility standard
that is equal to 133%
of the nonfarm |
| income official poverty line, as defined by
the federal | Office of Management and Budget and revised annually in
| accordance with Section 673(2) of the Omnibus Budget | Reconciliation Act of
1981, applicable to families of the | same size, provided that costs incurred
for medical care | are not taken into account in determining such income
| eligibility.
| (c) The Illinois Department may conduct a | demonstration in at least one
county that will provide | medical assistance to pregnant women, together
with their | infants and children up to one year of age,
where the | income
eligibility standard is set up to 185% of the | nonfarm income official
poverty line, as defined by the | federal Office of Management and Budget.
The Illinois | Department shall seek and obtain necessary authorization
| provided under federal law to implement such a | demonstration. Such
demonstration may establish resource | standards that are not more
restrictive than those | established under Article IV of this Code.
| 6. Persons under the age of 18 who fail to qualify as | dependent under
Article IV and who have insufficient income | and resources to meet the costs
of necessary medical care | to the maximum extent permitted under Title XIX
of the | Federal Social Security Act.
| 7. Persons who are under 21 years of age and would
| qualify as
disabled as defined under the Federal |
| Supplemental Security Income Program,
provided medical | service for such persons would be eligible for Federal
| Financial Participation, and provided the Illinois | Department determines that:
| (a) the person requires a level of care provided by | a hospital, skilled
nursing facility, or intermediate | care facility, as determined by a physician
licensed to | practice medicine in all its branches;
| (b) it is appropriate to provide such care outside | of an institution, as
determined by a physician | licensed to practice medicine in all its branches;
| (c) the estimated amount which would be expended | for care outside the
institution is not greater than | the estimated amount which would be
expended in an | institution.
| 8. Persons who become ineligible for basic maintenance | assistance
under Article IV of this Code in programs | administered by the Illinois
Department due to employment | earnings and persons in
assistance units comprised of | adults and children who become ineligible for
basic | maintenance assistance under Article VI of this Code due to
| employment earnings. The plan for coverage for this class | of persons shall:
| (a) extend the medical assistance coverage for up | to 12 months following
termination of basic | maintenance assistance; and
|
| (b) offer persons who have initially received 6 | months of the
coverage provided in paragraph (a) above, | the option of receiving an
additional 6 months of | coverage, subject to the following:
| (i) such coverage shall be pursuant to | provisions of the federal
Social Security Act;
| (ii) such coverage shall include all services | covered while the person
was eligible for basic | maintenance assistance;
| (iii) no premium shall be charged for such | coverage; and
| (iv) such coverage shall be suspended in the | event of a person's
failure without good cause to | file in a timely fashion reports required for
this | coverage under the Social Security Act and | coverage shall be reinstated
upon the filing of | such reports if the person remains otherwise | eligible.
| 9. Persons with acquired immunodeficiency syndrome | (AIDS) or with
AIDS-related conditions with respect to whom | there has been a determination
that but for home or | community-based services such individuals would
require | the level of care provided in an inpatient hospital, | skilled
nursing facility or intermediate care facility the | cost of which is
reimbursed under this Article. Assistance | shall be provided to such
persons to the maximum extent |
| permitted under Title
XIX of the Federal Social Security | Act.
| 10. Participants in the long-term care insurance | partnership program
established under the Illinois | Long-Term Care Partnership Program Act who meet the
| qualifications for protection of resources described in | Section 15 of that
Act.
| 11. Persons with disabilities who are employed and | eligible for Medicaid,
pursuant to Section | 1902(a)(10)(A)(ii)(xv) of the Social Security Act, and, | subject to federal approval, persons with a medically | improved disability who are employed and eligible for | Medicaid pursuant to Section 1902(a)(10)(A)(ii)(xvi) of | the Social Security Act, as
provided by the Illinois | Department by rule. In establishing eligibility standards | under this paragraph 11, the Department shall, subject to | federal approval: | (a) set the income eligibility standard at not | lower than 350% of the federal poverty level; | (b) exempt retirement accounts that the person | cannot access without penalty before the age
of 59 1/2, | and medical savings accounts established pursuant to | 26 U.S.C. 220; | (c) allow non-exempt assets up to $25,000 as to | those assets accumulated during periods of eligibility | under this paragraph 11; and
|
| (d) continue to apply subparagraphs (b) and (c) in | determining the eligibility of the person under this | Article even if the person loses eligibility under this | paragraph 11.
| 12. Subject to federal approval, persons who are | eligible for medical
assistance coverage under applicable | provisions of the federal Social Security
Act and the | federal Breast and Cervical Cancer Prevention and | Treatment Act of
2000. Those eligible persons are defined | to include, but not be limited to,
the following persons:
| (1) persons who have been screened for breast or | cervical cancer under
the U.S. Centers for Disease | Control and Prevention Breast and Cervical Cancer
| Program established under Title XV of the federal | Public Health Services Act in
accordance with the | requirements of Section 1504 of that Act as | administered by
the Illinois Department of Public | Health; and
| (2) persons whose screenings under the above | program were funded in whole
or in part by funds | appropriated to the Illinois Department of Public | Health
for breast or cervical cancer screening.
| "Medical assistance" under this paragraph 12 shall be | identical to the benefits
provided under the State's | approved plan under Title XIX of the Social Security
Act. | The Department must request federal approval of the |
| coverage under this
paragraph 12 within 30 days after the | effective date of this amendatory Act of
the 92nd General | Assembly.
| 13. Subject to appropriation and to federal approval, | persons living with HIV/AIDS who are not otherwise eligible | under this Article and who qualify for services covered | under Section 5-5.04 as provided by the Illinois Department | by rule.
| 14. Subject to the availability of funds for this | purpose, the Department may provide coverage under this | Article to persons who reside in Illinois who are not | eligible under any of the preceding paragraphs and who meet | the income guidelines of paragraph 2(a) of this Section and | (i) have an application for asylum pending before the | federal Department of Homeland Security or on appeal before | a court of competent jurisdiction and are represented | either by counsel or by an advocate accredited by the | federal Department of Homeland Security and employed by a | not-for-profit organization in regard to that application | or appeal, or (ii) are receiving services through a | federally funded torture treatment center. Medical | coverage under this paragraph 14 may be provided for up to | 24 continuous months from the initial eligibility date so | long as an individual continues to satisfy the criteria of | this paragraph 14. If an individual has an appeal pending | regarding an application for asylum before the Department |
| of Homeland Security, eligibility under this paragraph 14 | may be extended until a final decision is rendered on the | appeal. The Department may adopt rules governing the | implementation of this paragraph 14.
| 15. Family Care Eligibility. | (a) A caretaker relative who is 19 years of age or | older when countable income is at or below 185% of the | Federal Poverty Level Guidelines, as published | annually in the Federal Register, for the appropriate | family size. A person may not spend down to become | eligible under this paragraph 15. | (b) Eligibility shall be reviewed annually. | (c) Caretaker relatives enrolled under this | paragraph 15 in families with countable income above | 150% and at or below 185% of the Federal Poverty Level | Guidelines shall be counted as family members and pay | premiums as established under the Children's Health | Insurance Program Act. | (d) Premiums shall be billed by and payable to the | Department or its authorized agent, on a monthly basis. | (e) The premium due date is the last day of the | month preceding the month of coverage. | (f) Individuals shall have a grace period through | 30 days the month of coverage to pay the premium. | (g) Failure to pay the full monthly premium by the | last day of the grace period shall result in |
| termination of coverage. | (h) Partial premium payments shall not be | refunded. | (i) Following termination of an individual's | coverage under this paragraph 15, the following action | is required before the individual can be re-enrolled: | (1) A new application must be completed and the | individual must be determined otherwise eligible. | (2) There must be full payment of premiums due | under this Code, the Children's Health Insurance | Program Act, the Covering ALL KIDS Health | Insurance Act, or any other healthcare program | administered by the Department for periods in | which a premium was owed and not paid for the | individual. | (3) The first month's premium must be paid if | there was an unpaid premium on the date the | individual's previous coverage was canceled. | The Department is authorized to implement the | provisions of this amendatory Act of the 95th General | Assembly by adopting the medical assistance rules in effect | as of October 1, 2007, at 89 Ill. Admin. Code 125, and at | 89 Ill. Admin. Code 120.32 along with only those changes | necessary to conform to federal Medicaid requirements, | federal laws, and federal regulations, including but not | limited to Section 1931 of the Social Security Act (42 |
| U.S.C. Sec. 1396u-1), as interpreted by the U.S. Department | of Health and Human Services, and the countable income | eligibility standard authorized by this paragraph 15. The | Department may not otherwise adopt any rule to implement | this increase except as authorized by law, to meet the | eligibility standards authorized by the federal government | in the Medicaid State Plan or the Title XXI Plan, or to | meet an order from the federal government or any court. | 16. 15. Subject to appropriation, uninsured persons | who are not otherwise eligible under this Section who have | been certified and referred by the Department of Public | Health as having been screened and found to need diagnostic | evaluation or treatment, or both diagnostic evaluation and | treatment, for prostate or testicular cancer. For the | purposes of this paragraph 16 15 , uninsured persons are | those who do not have creditable coverage, as defined under | the Health Insurance Portability and Accountability Act, | or have otherwise exhausted any insurance benefits they may | have had, for prostate or testicular cancer diagnostic | evaluation or treatment, or both diagnostic evaluation and | treatment.
To be eligible, a person must furnish a Social | Security number.
A person's assets are exempt from | consideration in determining eligibility under this | paragraph 16 15 .
Such persons shall be eligible for medical | assistance under this paragraph 16 15 for so long as they | need treatment for the cancer. A person shall be considered |
| to need treatment if, in the opinion of the person's | treating physician, the person requires therapy directed | toward cure or palliation of prostate or testicular cancer, | including recurrent metastatic cancer that is a known or | presumed complication of prostate or testicular cancer and | complications resulting from the treatment modalities | themselves. Persons who require only routine monitoring | services are not considered to need treatment.
"Medical | assistance" under this paragraph 16 15 shall be identical | to the benefits provided under the State's approved plan | under Title XIX of the Social Security Act.
Notwithstanding | any other provision of law, the Department (i) does not | have a claim against the estate of a deceased recipient of | services under this paragraph 16 15 and (ii) does not have | a lien against any homestead property or other legal or | equitable real property interest owned by a recipient of | services under this paragraph 16 15 . | In implementing the provisions of Public Act 96-20 this | amendatory Act of the 96th General Assembly , the Department is | authorized to adopt only those rules necessary, including | emergency rules. Nothing in Public Act 96-20 this amendatory | Act of the 96th General Assembly permits the Department to | adopt rules or issue a decision that expands eligibility for | the FamilyCare Program to a person whose income exceeds 185% of | the Federal Poverty Level as determined from time to time by | the U.S. Department of Health and Human Services, unless the |
| Department is provided with express statutory authority. | The Illinois Department and the Governor shall provide a | plan for
coverage of the persons eligible under paragraph 7 as | soon as possible after
July 1, 1984.
| The eligibility of any such person for medical assistance | under this
Article is not affected by the payment of any grant | under the Senior
Citizens and Disabled Persons Property Tax | Relief and Pharmaceutical
Assistance Act or any distributions | or items of income described under
subparagraph (X) of
| paragraph (2) of subsection (a) of Section 203 of the Illinois | Income Tax
Act. The Department shall by rule establish the | amounts of
assets to be disregarded in determining eligibility | for medical assistance,
which shall at a minimum equal the | amounts to be disregarded under the
Federal Supplemental | Security Income Program. The amount of assets of a
single | person to be disregarded
shall not be less than $2,000, and the | amount of assets of a married couple
to be disregarded shall | not be less than $3,000.
| To the extent permitted under federal law, any person found | guilty of a
second violation of Article VIIIA
shall be | ineligible for medical assistance under this Article, as | provided
in Section 8A-8.
| The eligibility of any person for medical assistance under | this Article
shall not be affected by the receipt by the person | of donations or benefits
from fundraisers held for the person | in cases of serious illness,
as long as neither the person nor |
| members of the person's family
have actual control over the | donations or benefits or the disbursement
of the donations or | benefits.
| (Source: P.A. 95-546, eff. 8-29-07; 95-1055, eff. 4-10-09; | 96-20, eff. 6-30-09; 96-181, eff. 8-10-09; 96-328, eff. | 8-11-09; 96-567, eff. 1-1-10; revised 9-25-09.)
| (305 ILCS 5/5-5.5) (from Ch. 23, par. 5-5.5)
| Sec. 5-5.5. Elements of Payment Rate.
| (a) The Department of Healthcare and Family Services shall | develop a prospective method for
determining payment rates for | skilled nursing and intermediate care
services in nursing | facilities composed of the following cost elements:
| (1) Standard Services, with the cost of this component | being determined
by taking into account the actual costs to | the facilities of these services
subject to cost ceilings | to be defined in the Department's rules.
| (2) Resident Services, with the cost of this component | being
determined by taking into account the actual costs, | needs and utilization
of these services, as derived from an | assessment of the resident needs in
the nursing facilities. | The Department shall adopt rules governing
reimbursement | for resident services as listed in Section 5-1.1. Surveys | or
assessments of resident needs under this Section shall | include a review by
the facility of the results of such | assessments and a discussion of issues
in dispute with |
| authorized survey staff, unless the facility elects not to
| participate in such a review process. Surveys or | assessments of resident
needs under this Section may be | conducted semi-annually and payment rates
relating to | resident services may be changed on a semi-annual basis. | The
Illinois Department shall initiate a project, either on | a pilot basis or
Statewide, to reimburse the cost of | resident services based on a
methodology which utilizes an | assessment of resident needs to determine the
level of | reimbursement. This methodology shall be different from | the
payment criteria for resident services utilized by the | Illinois Department
on July 1, 1981. On March 1, 1982, and | each year thereafter, until such
time when the Illinois | Department adopts the methodology used in such
project for | use statewide,
the Illinois Department shall report to the | General Assembly on the
implementation and progress of such | project. The report shall include:
| (A) A statement of the Illinois Department's goals | and objectives
for such project;
| (B) A description of such project, including the | number and type of
nursing facilities involved in the | project;
| (C) A description of the methodology used in such | project;
| (D) A description of the Illinois Department's | application of the
methodology;
|
| (E) A statement on the methodology's effect on the | quality of care
given to residents in the sample | nursing facilities; and
| (F) A statement on the cost of the methodology used | in such project
and a comparison of this cost with the | cost of the current payment criteria.
| (3) Ancillary Services, with the payment rate being | developed for
each individual type of service. Payment | shall be made only when
authorized under procedures | developed by the Department of Healthcare and Family | Services.
| (4) Nurse's Aide Training, with the cost of this | component being
determined by taking into account the | actual cost to the facilities of
such training.
| (5) Real Estate Taxes, with the cost of this component | being
determined by taking into account the figures | contained in the most
currently available cost reports | (with no imposition of maximums) updated
to the midpoint of | the current rate year for long term care services
rendered | between July 1, 1984 and June 30, 1985, and with the cost | of this
component being determined by taking into account | the actual 1983 taxes for
which the nursing homes were | assessed (with no imposition of maximums)
updated to the | midpoint of the current rate year for long term care
| services rendered between July 1, 1985 and June 30, 1986.
| (b) In developing a prospective method for determining |
| payment rates
for skilled nursing and intermediate care | services in nursing facilities,
the Department of Healthcare | and Family Services shall consider the following cost elements:
| (1) Reasonable capital cost determined by utilizing | incurred interest
rate and the current value of the | investment, including land, utilizing
composite rates, or | by utilizing such other reasonable cost related methods
| determined by the Department. However, beginning with the | rate
reimbursement period effective July 1, 1987, the | Department shall be
prohibited from establishing, | including, and implementing any depreciation
factor in | calculating the capital cost element.
| (2) Profit, with the actual amount being produced and | accruing to
the providers in the form of a return on their | total investment, on the
basis of their ability to | economically and efficiently deliver a type
of service. The | method of payment may assure the opportunity for a
profit, | but shall not guarantee or establish a specific amount as a | cost.
| (c) The Illinois Department may implement the amendatory | changes to
this Section made by this amendatory Act of 1991 | through the use of
emergency rules in accordance with the | provisions of Section 5.02 of the
Illinois Administrative | Procedure Act. For purposes of the Illinois
Administrative | Procedure Act, the adoption of rules to implement the
| amendatory changes to this Section made by this amendatory
Act |
| of 1991 shall be deemed an emergency and necessary for the | public
interest, safety and welfare.
| (d) No later than January 1, 2001, the Department of Public | Aid shall file
with the Joint Committee on Administrative | Rules, pursuant to the Illinois
Administrative Procedure
Act,
a | proposed rule, or a proposed amendment to an existing rule, | regarding payment
for appropriate services, including | assessment, care planning, discharge
planning, and treatment
| provided by nursing facilities to residents who have a serious | mental
illness.
| (Source: P.A. 95-331, eff. 8-21-07.)
| (305 ILCS 5/12-8.2 new) | Sec. 12-8.2. Medical Assistance Dental Reimbursement | Revolving Fund. There is created a revolving fund to be known | as the Medical Assistance Dental Reimbursement Revolving Fund, | to be held by the Director of the Department of Healthcare and | Family Services, outside of the State treasury, for the | following purposes: | (1) The deposit of all funds to pay for dental services | provided by enrolled dental service providers for services | to participants in the medical programs administered by the | Department. | (2) The deposit of any interest accrued by the | revolving fund, which interest shall be available to pay | for dental services provided by enrolled dental service |
| providers for services to participants in the medical | programs administered by the Department. | (3) The payment of amounts to enrolled dental service | providers for dental services provided to participants in | the medical programs administered by the Department.
| (305 ILCS 5/5-5.8a rep.)
| (305 ILCS 5/5-22 rep.)
| Section 15. The Illinois Public Aid Code is amended by | repealing Sections 5-5.8a and 5-22.
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Effective Date: 1/1/2011
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