Public Act 098-0727
 
HB4600 EnrolledLRB098 17867 KTG 52991 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 Illinois Public Aid Code is amended  by 
changing Section 5-5.2 as follows:
 
 

    (305 ILCS 5/5-5.2)  (from Ch. 23, par. 5-5.2)

 
    Sec. 5-5.2. Payment. 

    (a) All nursing facilities that are grouped pursuant to 
Section
5-5.1 of this Act shall receive the same rate of 
payment for similar
services.

    (b) It shall be a matter of State policy that the Illinois 
Department
shall utilize a uniform billing cycle throughout the 
State for the
long-term care providers.

    (c) Notwithstanding any other provisions of this Code, the 
methodologies for reimbursement of nursing services as 
provided under this Article shall no longer be applicable for 
bills payable for nursing services rendered on or after a new 
reimbursement system based on the Resource Utilization Groups 
(RUGs) has been fully operationalized, which shall take effect 
for services provided on or after January 1, 2014. 
    (d) The new nursing services reimbursement methodology 
utilizing RUG-IV 48 grouper model, which shall be referred to 
as the RUGs reimbursement system, taking effect January 1, 
2014, shall be based on the following:   
        (1)   The methodology shall be resident-driven, 
    facility-specific, and cost-based.   
        (2) Costs shall be annually rebased and case mix index 
    quarterly updated. The nursing services methodology will 
    be assigned to the Medicaid enrolled residents on record as 
    of 30 days prior to the beginning of the rate period in the 
    Department's Medicaid Management Information System (MMIS) 
    as present on the last day of the second quarter preceding 
    the rate period based upon the Assessment Reference Date of 
    the Minimum Data Set (MDS).  
        (3)   Regional wage adjustors based on the Health Service 
    Areas (HSA) groupings and adjusters in effect on April 30, 
    2012 shall be included.  
        (4)   Case mix index shall be assigned to each resident 
    class based on the Centers for Medicare and Medicaid 
    Services staff time measurement study in effect on July 1, 
    2013, utilizing an index maximization approach.
        (5)   The pool of funds available for distribution by 
    case mix and the base facility rate shall be determined 
    using the formula contained in subsection (d-1). 
    (d-1)   Calculation of base year Statewide RUG-IV nursing 
base per diem rate. 
        (1)  Base rate spending pool shall be: 
            (A)   The base year resident days which are 
        calculated by multiplying the number of Medicaid 
        residents in each nursing home as indicated in the MDS 
        data defined in paragraph (4) by 365.
            (B)   Each facility's nursing component per diem in 
        effect on July 1, 2012 shall be multiplied by 
        subsection (A).
            (C)   Thirteen million is added to the product of 
        subparagraph (A) and subparagraph (B) to adjust for the 
        exclusion of nursing homes defined in paragraph (5). 
        (2)  For each nursing home with Medicaid residents as 
    indicated by the MDS data defined in paragraph (4), 
    weighted days adjusted for case mix and regional wage 
    adjustment shall be calculated.  For each home this 
    calculation is the product of:
            (A)   Base year resident days as calculated in 
        subparagraph (A) of paragraph (1).
            (B)   The nursing home's regional wage adjustor 
        based on the Health Service Areas (HSA) groupings and 
        adjustors in effect on April 30, 2012.
            (C)   Facility weighted case mix which is the number 
        of Medicaid residents as indicated by the MDS data 
        defined in paragraph (4) multiplied by the associated 
        case weight for the RUG-IV 48 grouper model using 
        standard RUG-IV procedures for index maximization.
            (D)   The sum of the products calculated for each 
        nursing home in subparagraphs (A) through (C) above 
        shall be the base year case mix, rate adjusted weighted 
        days.
        (3)  The Statewide RUG-IV nursing base per diem rate on 
    January 1, 2014 shall be the quotient of the paragraph (1) 
    divided by  the sum calculated under subparagraph (D) of 
    paragraph (2).
        (4)  Minimum Data Set (MDS) comprehensive assessments 
    for Medicaid residents on the last day of the quarter used 
    to establish the base rate.
        (5)  Nursing facilities designated as of July 1, 2012 by 
    the Department as "Institutions for Mental Disease" shall 
    be excluded from all calculations under this subsection.  
    The data from these facilities shall not be used in the 
    computations described in paragraphs (1) through (4) above  
    to establish the base rate. 
    (e) Notwithstanding any other provision of this Code, the 
Department shall by rule develop a  reimbursement methodology 
reflective of  the intensity of care and services requirements 
of low need residents in the lowest RUG IV groupers and 
corresponding regulations. Only that portion of the RUGs 
Reimbursement System spending pool described in subsection 
(d-1) attributed to the groupers as of July 1, 2013 for which 
the methodology in this Section is developed may be diverted 
for this purpose. The Department shall submit the rules no 
later than January 1, 2014 for an implementation date no later 
than January 1, 2015. If the Department does not implement this 
reimbursement methodology by the required date, the nursing 
component per diem on January 1, 2015 for residents classified 
in RUG-IV groups PA1, PA2, BA1, and BA2 shall be the blended 
rate of the calculated RUG-IV nursing component per diem and 
the nursing component per diem in effect on July 1, 2012. This 
blended rate shall be applied only to nursing homes whose 
resident population is greater than or equal to 70% of the 
total residents served and whose RUG-IV nursing component per 
diem rate is less than the nursing component per diem in effect 
on July 1, 2012. This blended rate shall be in effect until the 
reimbursement methodology is implemented or until July 1, 2019, 
whichever is sooner. 
    (e-1)   Notwithstanding any other provision of this Article, 
rates established pursuant to this subsection shall not apply 
to any and all nursing facilities designated by the Department 
as "Institutions for Mental Disease" and shall be excluded from 
the RUGs Reimbursement System applicable to facilities not 
designated as "Institutions for the Mentally Diseased" by the 
Department.
    (e-2) For dates of services beginning January 1, 2014, the 
RUG-IV nursing component per diem for a nursing home shall be 
the product of the statewide RUG-IV nursing base per diem rate, 
the facility average case mix index, and the regional wage 
adjustor.   Transition rates for services provided between 
January 1, 2014 and December 31, 2014 shall be as follows:
        (1)   The transition RUG-IV per diem nursing rate for 
    nursing homes whose rate calculated in this subsection 
    (e-2) is greater than the nursing component rate in effect 
    July 1, 2012 shall be paid the sum of:
            (A)   The nursing component rate in effect July 1, 
        2012; plus
            (B)   The difference of the RUG-IV nursing component 
        per diem calculated for the current quarter minus the 
        nursing component rate in effect July 1, 2012 
        multiplied by 0.88.
        (2)   The transition RUG-IV per diem nursing rate for 
    nursing homes whose rate calculated in this subsection 
    (e-2) is less than the nursing component rate in effect 
    July 1, 2012 shall be paid the sum of:
            (A)   The nursing component rate in effect July 1, 
        2012; plus
            (B)   The difference of the RUG-IV nursing component 
        per diem calculated for the current quarter minus the 
        nursing component rate in effect July 1, 2012 
        multiplied by 0.13. 
    (f)  Notwithstanding any other provision of this Code, on 
and after July 1, 2012, reimbursement rates associated with the 
nursing or support components of the current nursing facility 
rate methodology shall not increase beyond the level effective 
May 1, 2011 until a new reimbursement system based on the RUGs 
IV 48 grouper model has been fully operationalized.
    (g) Notwithstanding any other provision of this Code, on 
and after July 1, 2012, for facilities not designated by the 
Department of Healthcare and Family Services as "Institutions 
for Mental Disease", rates effective May 1, 2011 shall be 
adjusted as follows:
        (1) Individual nursing rates for residents classified 
    in RUG IV groups PA1, PA2, BA1, and BA2 during the quarter 
    ending March 31, 2012 shall be reduced by 10%;
        (2) Individual nursing rates for residents classified 
    in all other RUG IV groups shall be reduced by 1.0%;
        (3) Facility rates for the capital and support 
    components shall be reduced by 1.7%.
    (h) Notwithstanding any other provision of this Code, on 
and after July 1, 2012,  nursing facilities designated by the 
Department of Healthcare and Family Services as "Institutions 
for Mental Disease" and "Institutions for Mental Disease" that 
are facilities licensed under the Specialized Mental Health 
Rehabilitation Act of 2013 shall have the nursing, 
socio-developmental, capital, and support components of their 
reimbursement rate effective May 1, 2011 reduced in total by 
2.7%.
(Source: P.A. 97-689, eff. 6-14-12; 98-104, Article 6, Section 
6-240, eff. 7-22-13; 98-104, Article 11, Section 11-35, eff. 
7-22-13; revised 9-19-13.)

 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law. 
  


Effective Date:  7/16/2014