Illinois General Assembly - Full Text of Public Act 093-1087
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Public Act 093-1087


 

Public Act 1087 93RD GENERAL ASSEMBLY



 


 
Public Act 093-1087
 
HB0699 Enrolled LRB093 05498 MKM 05589 b

    AN ACT in relation to public aid.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Public Aid Code is amended by
changing Section 5-5.4 as follows:
 
    (305 ILCS 5/5-5.4)  (from Ch. 23, par. 5-5.4)
    Sec. 5-5.4. Standards of Payment - Department of Public
Aid. The Department of Public Aid shall develop standards of
payment of skilled nursing and intermediate care services in
facilities providing such services under this Article which:
    (1) Provide for the determination of a facility's payment
for skilled nursing and intermediate care services on a
prospective basis. The amount of the payment rate for all
nursing facilities certified by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities, Long Term Care for Under
Age 22 facilities, Skilled Nursing facilities, or Intermediate
Care facilities under the medical assistance program shall be
prospectively established annually on the basis of historical,
financial, and statistical data reflecting actual costs from
prior years, which shall be applied to the current rate year
and updated for inflation, except that the capital cost element
for newly constructed facilities shall be based upon projected
budgets. The annually established payment rate shall take
effect on July 1 in 1984 and subsequent years. No rate increase
and no update for inflation shall be provided on or after July
1, 1994 and before July 1, 2005, unless specifically provided
for in this Section. The changes made by this amendatory Act of
the 93rd General Assembly extending the duration of the
prohibition against a rate increase or update for inflation are
effective retroactive to July 1, 2004.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on July 1, 1998
shall include an increase of 3%. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Skilled Nursing facilities or Intermediate Care facilities,
the rates taking effect on July 1, 1998 shall include an
increase of 3% plus $1.10 per resident-day, as defined by the
Department.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on July 1, 1999
shall include an increase of 1.6% plus $3.00 per resident-day,
as defined by the Department. For facilities licensed by the
Department of Public Health under the Nursing Home Care Act as
Skilled Nursing facilities or Intermediate Care facilities,
the rates taking effect on July 1, 1999 shall include an
increase of 1.6% and, for services provided on or after October
1, 1999, shall be increased by $4.00 per resident-day, as
defined by the Department.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on July 1, 2000
shall include an increase of 2.5% per resident-day, as defined
by the Department. For facilities licensed by the Department of
Public Health under the Nursing Home Care Act as Skilled
Nursing facilities or Intermediate Care facilities, the rates
taking effect on July 1, 2000 shall include an increase of 2.5%
per resident-day, as defined by the Department.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities
or intermediate care facilities, a new payment methodology must
be implemented for the nursing component of the rate effective
July 1, 2003. The Department of Public Aid shall develop the
new payment methodology using the Minimum Data Set (MDS) as the
instrument to collect information concerning nursing home
resident condition necessary to compute the rate. The
Department of Public Aid shall develop the new payment
methodology to meet the unique needs of Illinois nursing home
residents while remaining subject to the appropriations
provided by the General Assembly. A transition period from the
payment methodology in effect on June 30, 2003 to the payment
methodology in effect on July 1, 2003 shall be provided for a
period not exceeding 2 years after implementation of the new
payment methodology as follows:
        (A) For a facility that would receive a lower nursing
    component rate per patient day under the new system than
    the facility received effective on the date immediately
    preceding the date that the Department implements the new
    payment methodology, the nursing component rate per
    patient day for the facility shall be held at the level in
    effect on the date immediately preceding the date that the
    Department implements the new payment methodology until a
    higher nursing component rate of reimbursement is achieved
    by that facility.
        (B) For a facility that would receive a higher nursing
    component rate per patient day under the payment
    methodology in effect on July 1, 2003 than the facility
    received effective on the date immediately preceding the
    date that the Department implements the new payment
    methodology, the nursing component rate per patient day for
    the facility shall be adjusted.
        (C) Notwithstanding paragraphs (A) and (B), the
    nursing component rate per patient day for the facility
    shall be adjusted subject to appropriations provided by the
    General Assembly.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on March 1, 2001
shall include a statewide increase of 7.85%, as defined by the
Department.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or Long Term Care for Under
Age 22 facilities, the rates taking effect on April 1, 2002
shall include a statewide increase of 2.0%, as defined by the
Department. This increase terminates on July 1, 2002; beginning
July 1, 2002 these rates are reduced to the level of the rates
in effect on March 31, 2002, as defined by the Department.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as skilled nursing facilities
or intermediate care facilities, the rates taking effect on
July 1, 2001 shall be computed using the most recent cost
reports on file with the Department of Public Aid no later than
April 1, 2000, updated for inflation to January 1, 2001. For
rates effective July 1, 2001 only, rates shall be the greater
of the rate computed for July 1, 2001 or the rate effective on
June 30, 2001.
    Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the Illinois Department shall
determine by rule the rates taking effect on July 1, 2002,
which shall be 5.9% less than the rates in effect on June 30,
2002.
    Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, if the payment methodologies
required under Section 5A-12 and the waiver granted under 42
CFR 433.68 are approved by the United States Centers for
Medicare and Medicaid Services, the rates taking effect on July
1, 2004 shall be 3.0% greater than the rates in effect on June
30, 2004. These rates shall take effect only upon approval and
implementation of the payment methodologies required under
Section 5A-12.
    Notwithstanding any other provisions of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, the rates taking effect on
January 1, 2005 shall be 3% more than the rates in effect on
December 31, 2004.
    For facilities licensed by the Department of Public Health
under the Nursing Home Care Act as Intermediate Care for the
Developmentally Disabled facilities or as long-term care
facilities for residents under 22 years of age, the rates
taking effect on July 1, 2003 shall include a statewide
increase of 4%, as defined by the Department.
    Notwithstanding any other provision of this Section, for
facilities licensed by the Department of Public Health under
the Nursing Home Care Act as skilled nursing facilities or
intermediate care facilities, effective January 1, 2005,
facility rates shall be increased by the difference between (i)
a facility's per diem property, liability, and malpractice
insurance costs as reported in the cost report filed with the
Department of Public Aid and used to establish rates effective
July 1, 2001 and (ii) those same costs as reported in the
facility's 2002 cost report. These costs shall be passed
through to the facility without caps or limitations, except for
adjustments required under normal auditing procedures.
    Rates established effective each July 1 shall govern
payment for services rendered throughout that fiscal year,
except that rates established on July 1, 1996 shall be
increased by 6.8% for services provided on or after January 1,
1997. Such rates will be based upon the rates calculated for
the year beginning July 1, 1990, and for subsequent years
thereafter until June 30, 2001 shall be based on the facility
cost reports for the facility fiscal year ending at any point
in time during the previous calendar year, updated to the
midpoint of the rate year. The cost report shall be on file
with the Department no later than April 1 of the current rate
year. Should the cost report not be on file by April 1, the
Department shall base the rate on the latest cost report filed
by each skilled care facility and intermediate care facility,
updated to the midpoint of the current rate year. In
determining rates for services rendered on and after July 1,
1985, fixed time shall not be computed at less than zero. The
Department shall not make any alterations of regulations which
would reduce any component of the Medicaid rate to a level
below what that component would have been utilizing in the rate
effective on July 1, 1984.
    (2) Shall take into account the actual costs incurred by
facilities in providing services for recipients of skilled
nursing and intermediate care services under the medical
assistance program.
    (3) Shall take into account the medical and psycho-social
characteristics and needs of the patients.
    (4) Shall take into account the actual costs incurred by
facilities in meeting licensing and certification standards
imposed and prescribed by the State of Illinois, any of its
political subdivisions or municipalities and by the U.S.
Department of Health and Human Services pursuant to Title XIX
of the Social Security Act.
    The Department of Public Aid shall develop precise
standards for payments to reimburse nursing facilities for any
utilization of appropriate rehabilitative personnel for the
provision of rehabilitative services which is authorized by
federal regulations, including reimbursement for services
provided by qualified therapists or qualified assistants, and
which is in accordance with accepted professional practices.
Reimbursement also may be made for utilization of other
supportive personnel under appropriate supervision.
(Source: P.A. 92-10, eff. 6-11-01; 92-31, eff. 6-28-01; 92-597,
eff. 6-28-02; 92-651, eff. 7-11-02; 92-848, eff. 1-1-03; 93-20,
eff. 6-20-03; 93-649, eff. 1-8-04; 93-659, eff. 2-3-04; 93-841,
eff. 7-30-04.)
 
    Section 99. Effective date. This Act takes effect January
1, 2005.